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HomeMy WebLinkAboutSubmittal-Commissioner Sarnoff 2MIAMI POLICE DEPARTMENT SUBMITTED INTO THE PUBLIC RECO!:D FOR ITEMbLiON :f/o . COCONUT GROVE VILLAGE Under Age Drinking Arrests 000cy_ Su b►'�'�i a�_ Coma), ssioner rnoff 2 DVS HUGER COMPLA1NT/ARREST AFFIDAVI1 Cpie1 oa3---1• COURT CASE NO. SPECIAL OPERATION: OFFJ-CetrY D D7RAFFIC OJW DDV DMDVES DON LIVE OWARRAM+i. FUGITIVE u1 of WARRANT: Din stale ❑0slate JAIL I'1D. PMHO �, 1 Yes J r FRAUD --- VS NO. - eGENCY CODE MUNICIPAL PD. DEC. ID NO. MDPO RECORDS AND ID NO. STUDENT D NO. GANG ACTIVITY RELATED. ARREST RELATED ❑ ARREST DEFEND N. 'I c7 R, MIDDLE) r;: `r} ` ALIAS and / or STREET NAME BIGNAL: ❑ 100 ❑ 150 ❑ 200 O 300 D Boa ❑ 500 .. r ' �{a�.��ett -,—,•C•^ems ;n+i+i . �. u"r L`�r ,c,..•.• THAIR E1"E E MASSES FACIAL• WVIR• TEETH DOB (AUUDD W�. ?-O i Ti AG 1 I I, • .. ❑Nlsperac hrusparYc .. c I— '5 NEIGH7 /HT 1 .WEIGHT 170 COLOR ��L HAIR LENGTH 1►, r21 HAIR STYLE ST11 -�I Yn5�11{ D Yes io 6,b111F 1� SCARS. TATTOOS, UNIQUE PHYSICAL s! FEATURES (LooGon, ETHNICITY: Type. Desviplion) _ PLACE OF BIRTH (City, Slala7Cnriry) . . 19 LOCAL ADDRESS (Street -AFL t,.ApL N .l J+� f Q. I o py)..... (sine).... ... (Zp) T S-I f51 6 i-r e b a t t FJ gt.-Y LP L 1 111\ PHONE. ( 3 _ .. .-.. .crtiZEN• _. -. ' � PERMANENT ADDRESS (Basel, Apt, Nuillbar) 0 HOEL MESS O UNKNOWN .... .. .. — . -/ (�Y) ._.... - - (S1a1e1Courirl') - • U� P) PHONE — .._. — OCCUPATION SOURCE II D_ O BUSINESS OR 0 SCHOOL NAME AN0 ADOREs5 (Street) (CM (SIawJCaun+ry) PP) PHONE PHONE ADDRESS Verbal 0 \If OF:y� N UNK DRIVER'S LICENSE NUMBER / STATE -'/T `i'}-�j_�� ` BO _ 3 2-1 t SOCIAL SECURITY NO. `-' i 1 ' 6 A °- . J\f �- 1 WEAPON SE=D7 Type ❑ Yes' Def. has Concealed Weapons Permit. PERMR W- INDICATION Alcohol inAuerrrj'y.j 0n19 'vAluerr�:( ❑ :. ❑ ❑ GRID ARREST DI U ATE (/DONYYY) ' q ARP:EST TIME (HHM ) ARREST indld ST LOCATION (e name of aasiness) CO-DEFENDANT NAME (ast, Fist. Midde)• DOB (WAf00/YYYY)i . 0 MN CUSTODY 0 FELONY `❑ JLIVFNILE ❑ AT LARCf. ,. p Dv... _ . .. D MI50—=ME4NOR ..CO-DEFENDANT NAME (Last. Fist,. Middle) _ ._ -_. .. .. _.„DOB (MMDP Y1.'_ ._.-❑IN-L7JGT: .......-... _ .. •••• . ..,. .._.. n_ .. ..... .-_... _ _ 0 FELONY ❑JUVENILE ❑ AT ' ❑ .DV_ ....D MISprD4EANW .... Gc ... CO-OE-ENDANT NAME ' F. Middle) DOB (MIrJOD/1^'YY)0 _..❑ .. _ .._ __. e� __ 0 Ah --MILD 0 MISDEMEANOR ANi LV LARGE 0 DV -.. JW only • (Nana) (Ste+_: .API. T-. Nuer) ., (Cal)(3=�JCa_�rr7) g.td) (Piose) ❑Forst( .. .. ❑ Ys ' _ ., ❑ Gtarfian• .. { ....) _. . p No • C O rvser'ca'-i• -- - _ . i T RE OR ice FFIC. cr.03 ON .. .. _. CHARG=S CHAR. GP AS: COUNTS( . - R Si ATIJTS NUMBER ....VOLOF SECT CDDE OF UCR . . Ov ... WARRA N 0SW DRY 0PwOJv✓PU ❑AW 6 Poss . of an Alcoholic -Bev. ❑ ES.. J' 1w 'a person under 21 YOA. ❑ °RD . 1. 5,b2. 1 1 1. f ❑aD OCAP45 ❑DVW ❑w ", ❑ v✓ ❑PwLINK) ❑AW 0 F.S. 2. ' .. ❑ DPI 7j77 II ❑Ac ❑CAPIAS osW ❑OVW ❑WP!T cABE a: . . • OFW 0PW❑ALVPU [kW 0 F.S. 3 ❑ on .. - ' ❑Ac.❑CAPIti- paw ❑DVW ❑WR7 : . CASE 7.' • ❑BW*❑FW0PWDJUVPU PAW ❑ F.S. ❑ ORD OAC ❑0APIAS ODVW,OWPJT .. . . CASE 5: • Tne roc certifies and sweai3 that he/she tvs jux and sj.a� grounds to betiere, and does believe Cia1 the z mfr. rrasmed{DjgpZ'.Anl comMte5 the �f llo n9 `riciaation of our, On Vl t J day 5 — " i2. f 2D n.. J at Q1 in. at • .' v 1 D ''FV WI _Y 2 ._.. (NaRadt•e, h° sp'dir). , (IiHMM) �✓ •� (la0don. include nave of business] '- This `officer observed' the .'Def : a youthful -looking person in posses.si-on of an alcoholic beverage to wit: 2,_„4 Def. is o YDA, DOB:/2 Per 562.47(3) F.S. this officer can attest to the intoxicating nature of said beverage_ . i submitted into the public record in connection with item DI.1 on 01-28-10 Priscilla A. Thompson City Clerk HOLD FOR BBNDYi`ER R WG. OO NOT BOND our cAtust•Appezat Bond Roaring). PAP --STATEMENT IS TRUE AND CORRECT. FICER'S / COAIPLAINANVS SIGNATURE COURT IC NUMBER/LOC. CODA Deputy or LCre Cwii o`GNozryPubfr_ understand dial should(whey tall to appear before IM.our1 as required by this rvdce b appear that I may be held in contempt of. court and a warrant t( my arrest shell be issued. Furthermore, f aft ow. aoree dial not= oxiariurn Cu tine_, date, and hearings shoiad be sent hide above address. • gree dial d ie my responsibility to roby Clerk of Se C 5 (tuvgryfeo notify Juvenae Division) arypme 6ia1 rDY address n9 . Sign`re of • -nl / Juvenle and Parent or Guarlbn Def_ was issued a Notice to Appear_ (right (hint print) 32_D2o4-g Rev. 04/08 c � O a r O. O • K 3 O (D .-e 3- I 5 (D scARs 3 < 0 cr .•f . LOCAL ADDRESS - F /a. AGENCY'COOE COMPLAINTIARREST AFFIDAI. MUNICIPAL PD. DEF. D NO. sex 'jj OHlsperJc ,ONd Hispar.tc ' ETHNICITY. :t . PERMANENT ADDRESS ( !''mar (StraeL'hoL Number) ❑'HOMELESS 0 UNKNOWN .. a BUSINESS OR/CH JR NAME ANO ADDRESS LICENSE N DER /STATE 3 0 _S 7-'0- ( E (MMJD.. COp EN rdsr.. hXME.Ilzs1 _qs_t, ) CA-OEFENDANT NAME (La- Firs, Middle) ...• (Street) ARREST TIME (HHMM) of=lam POLICE CASE ND. . JAIL NO. NDPD RECORDS AND ID ND. . STUDENT D• ALMS and / v STREETrN»4S _ .(Slate) /G '(Stare/Counvy) (SIaleJCeunoy) ARREST LOCATION .�;..th-t,r(c_. J "/ DOS (MW.O0/YYYTZ DDB (MNAD!YY(1�, (4) PHONE CpsRT SASE NO:.,+•' 0e1. hee Concealed Weapons Permit. PERMfTS W-. FRAUD •RELATED jr7 ARREST �Q GLASSES FACIAL HAIR TEETH O'Yei .. p /16t % 4►` (tj PLACE OF BIRTH (City, Stale/Country) Cam(% INDICATION OF: Y N LANK Noir( i.Suence 0 0 Drug Mnuerce: ❑''a D ..0'IN.CUSTOOY .0 !. 0 JtJtr—JJI_F.. .---' _0 AT, LARGE . _ D.DV.... . MusD—=PicaNl DOS. (MMFDDlYYYY) 0 IN CUSTODY 0 FELONY O JUVENILE 0 AT LARGE 0 DV O M:5DEMEANOR •41V /0 Parent ' (Nam-) • _ _. !hone.) • . _.__— _ n� CAS_"'_ cHARGEnSL CODA s ' STATUTE NUN=ER_ _V.IOL'DF.SE57_ c0}_Orc1 —LAC L�v-�_.w,YirgNi_i T„7E OR.,iZr,',,E,FIC Cr%,1ON.. . 0S5. OI -an _ canP_0C v23 _ e { Oka pcDavy Orw O�ry PU L7Aw ._ :a •—, •TI _L1-n • .4:-• r�-ors v+O.n •o ��7i.._ _..... The undersigned certifies a saes, that f&Jshe has just and reasonable grounds b believe, and does beFieve that Liee ahwa manned Dei=-ndati morrthted tt• blowing ! e) /% 20 .- � / (HHMM) a: �/ /02. . ❑AO Oc%.°L-a 0"5W Orly DPW ❑JUVPU DAw 0 DVW ❑WPri DAC.DCAPIAS DEW OFW DPW ❑JLV PU DAW ODVW OWR( CASE - .. 1DAC ❑CAPIAS OBW 0Pvw. OwRr Cji5E y OFw DPW ❑JUV PU OAW .-(Nane5ve, be sr_o'c•) (LDeebon. inciuw_.nane c bsinessl This of-ficer observed the De'f.'-a"you'thfui looking person"in-"possession-'of an Def. is ! 8 YOA, DOB 0.513 Def . ' was issued. Per 562.. 47(3) F. S _ this officer can attest -to the intoxicating nature HOLD FOR OTHER AGENCY Name: ' ' VERIFIED BY / SWEAR. AT THE ABOVE STAiNT IS TRUE AN31 6' ' ' ... MPLAINA GNA 32:02.4'>-e : Rev. 00.'OB ❑ HOLD FOR,£OND-FEAf2{NG. DO NOTBOND our (O5.Must appear at 'Bond Hearing). . Tr _-rev •. SWORN T15tD.SD9SC32(3E0 BEFOFcE ME� THE UNDc?S•IGN .iJ ii'• •• ;' COURT ID NUMBER/LOC. CODE DAY OF '; INIL•geggrAt - 4 Arr ./ a Ft c iE •errand thal should I willfully fail to appear beivre the cool as rewired by this.mtice fa appear that I may be held in contempt of Mir xd a vianant.k r +'y arrest shah be LSsued. Funherrinore, I ogre Stat nonce concerning the time, date, and place c2 all curt heariigs dduld'be sent to the above address. I agree that ills my respawbatty to notify perk, of the Court (Juveniles notify Amerds Division) anytime that my address tang You _ • not p -ar h court, but fraual comply • the oI - - er-e side h8r_• f• (/) (1) c 3 0 cr (1. 5. alp Er 0 on _13: ▪ (la Or+ re. 03 a• (D ▪ -0 0 ;1•• = n GETS NUMBER 'DEFENDA)iT'S AGENCY CODE OUE PH SICAL FEATURES C'a 1--,) Lnr_al ADDRESS (Street. Apt. Number) . !4/1/ -rt E-b 517---: co_o_A-L 647- W 'Y3/ 'PERMAnENT ADDRESS Muse( APL Number) .0 HOMELESS .0 UNKNOWN +Li --- 0 BUSINESS OR eLSCHOOL NAME AND ADDRESS (Lacafion, - / - COMPLAINT/ARREST AFFIDAl ETHNICITY: Type ...Des:Option) HAIR.COLDR POLIDE CASE NO. 0510/ 0 0303 STREET NAME DRWERS LJCENSE NUMBER / STATE 7,54 ARREST DATE (Mm/E/DfrYY) DANT NAmE Lae. First. Middle) CHARGES (Slreel) ARREST TIME (HAMM] ARREST ATIDN (iclude name of business ..3Y p9/._..e • (CilY) (StAe/Cnintly) • TZ.b) -"- e (zis )3 D OURT CARE NO. HAJR STYLE C V61/ GANG AC77vITY RELATED El ARREST FRAUD ARREST RELATED n SIGNAL: . . 0100 :0150 0 200 0300 0400 0 SOD EYES GLASSES FACIAL HAIR TEETH. CIL? /./) PLACE DF BIRTH ICIty, Stale Country) -CITIZENSHIP s (Stab/Country) OP) (Sbeel, AoLNumbar) DOB (264/DD/YYYY) DOS (MMADD/YYYY) . . . PHONE SEEM? Type Def. has Concealed Weapons Permit_ PERMIT 4' W. (Chy) (SMIA/Courrtry) CZIP) CHARGE AS: COUNTS .FL STATUTE NUMEE.0 . VIOL OP SECT 0 F-S. 0 ORD The undersigned certifies and swam het he/she has Jua., and reasonable grouncts to teaeee, and does bNieve On the5.o. day of I.) i9-: 41. 20 01 • r Z-545 it-4MM) at HOLD FOR OTHER AGENCY . • vZRIFfED ET OFFICER VE ATEMENT LS TRUE AND CORRECT. b2 PLAINANT. TURF_ .."'" COURT JO NUMB LSOC. CODE -eNCY NA 32.02.03-9 04JD8 (Lomeon. include name ol business) HOLD FOR.EIOND.EEARING. DO NOT SONS OUT(0626•Muit•Abfitbond Hearing). SWORN:AND.SDESS*ED SEFORE- MED : !•.• THE LINDERsiGNEDWYFHORITY-E-11S,: OCCUPATION ADDRESS SOURCE • . 0 Veloal ND/CATIDN OF: Y N UNK Alcohol Whence 0 A. 0 Drug inAuence: 0 ID 0 ConMclad? 0 Yes 0 No OCR. I DV I..... WARFLANT...PE OR TRAFFIC CrTAT)0N I OAC OCAPLAS Daw OFW OPN OJLry Pu DAw DOVVVO WRIT • ' „.. • •CASE ,: DAC °CAMAS OEW OFw OPW 0.1LIV Pu JAW ODVW DY/Rif CASE g: MAC OC:APLAS 03W 00,0 OFYi FU OAW quvw DART CASE 10 DAC OCAPIAS 05W OFW DPVY CAP/ PU OAW ODWY OARIT CASE at l'unclerstandat should I Nilfullysfail appeer before the mutt as tieed by alb nuke to appear Um! I nay 62 held in contempt of .court and. a -warrant for my-arrest...call be issued. Fufeerrnore, .1 •a5roa eminence oncerrtingtte time, date, and place of all court hearings shod be sera Id the abbee address. I agree 00001, my responsbEty to co* Clerk of the Court (Juvenito notify SerenZe Oirisba) arrilime thet my address changes. r7 You need not appe,r in c6urt., but must comply *eh the hstrucljons- eye side hereof. ,I2 a • Parent 0den (Narratiee, be specific) PAGEOF OBTS NUMBER SPECIAL DFELDNr Also DOuTnAFFIc /. OMDl•avEs pc-iv P _, _ OPERATE*& DwARRANr FUGrTIvE wARRANT: Or .lab .0O01 d slate CD CD C o cr 3 3 �. 0 a 3 A `,,,a 3' of O G °- 0 3 O �D •., S N S co 6 to 0 G a :LOCAL ADDRESS (Street, AGENCY CODE' MUNICIPAL PD. DEF. D N0. • 'S�M(�IIE PHYSSC.AL FEATURES (Location. Tpe: D p11on) • iPERMANENT ADDRESS {Street. Apt,'µurnber) D HOAiFI FCS ❑'uNICN D Eusc Es'MiiORy"ee(yf _ I4U 4BER / STATE ARI Sit 1. D NAME AND ADDRESS C0.,Dc__fpANT ;"1.4,1E. (Lest 5.-t, 1 COMPLAINT/ARREST AFFIDA4.. P°aDsEc )60,7e)sy ALIS and I or STREET NAME EIGHT WEIGHT HAIR COL . n (Sae] R9 N ..... ,wiry,_. / (Stale/County) (rsP� wEAPON SFr'Fn7 Type -O Yes WORT CASE NO. D &ASSES Yes No FACIAL HAIR �W I TEETH PLACE OF BIRTH (Cary, Staie/Caomy) CITIZENSHIP. . -eT0 i/S/ OCCVPAT ADDRESS SOURCE: 11 Del. has Concealed Weapons Persil FF_RMIT: W- / PEST LOCATION (»dude name &bsness) e/ ,I, •77 (Street A7_Number) (Slate/giro) PF) CHARGES . ...... . CHAP. -GE. .&...j CDUNTSi _ ..FL SATLFTE NUMBER . .12ROL..PF SECT CODE Or ..UCR •Poss.. of an Alcoholic Be.c_.:-D s: _ -DRrson under- ..21..VOA OD�.D':1 ' 562.1.11 , just and reas+nable Saunas b Aev., aid does bafieve that the ahv✓eerrmrcd'Def encannll c;.n„ vdaionn of lac 713 CJs.. % • el (1iHMM) . 111=tion. include name of business/ c n ..WERFANT T',-_ OR TRA.=FIC.CTTATION 0 OAC OCARES OSP/ DPP/ DPW DIJJPUDAW a; DDvw DWRIT ❑AC OCA°(s DEW OFW DPW DuwPJ DE DDvw DwRr DAD OcAPI;s • Dsw D FW D raw DJIN PU DAW ❑Dvw Dune CASE t. ' IDAC DcAPI:s OS W DFw OPYDJLNPUDAw ODvw DWRI CASE slk :This -Of fi.cer 'observed"the-Def . a' youthfiil' looking person in -possession •of' an. - alcoholic beverage to Wit: D.e f _ is _ 2/ YOA, DOB: Def. was issued a Notice to Appear. Per 562.47(3) F_S. this officer can attest to the intoxicating nature of said beverage. HOLD FOR 6i}fr'7R AGENCY Nave: I SWEAR. THAT VERIFIED BY • ' iEMENT IS TRUEAND CORRECT.. J. ' SWDRN eD..WO.SlTr3SCRI9ED BEi ^'—`� 3\�! � /r!e UNlJs-r-: _: ;Co-;4tFs 0pJ—T]ell PICER'S r r- „r INANT3 SIGNATURE)" COURT ID DNS—. 0C /// DAY OF ` r/ NAME (Printed) I20202-9- Rev. O4/pg AGENCY NAME Deputy or or3ioaryPtes- j I t..ia..and thal should I wEMty 09 m appear before the our, as 1 required by this notico la appear tiat l may be held in mnlerpt of mud aod.a warrant for my aomi shag be issred..Fu rthemnre, I ' agree but nodes =marting Eno time, dale. and plan: of all wort Twarfrus Mold to sent to the above address. I agree that it a my rapoaibdity b notify Clerk of the Corn (Juvenies notify Juverde Division) anydrke that my address dlarges. You rem nG apmer in orS, but, anal dryly With the r,SS ctioos an . _ _ bent. xlant . -tunas and Parent or Guardan (right thumb pint) COMPLAINT/ARREST AFFIDAV; i ACC. 09oi SD. 35b ISPEC.I : DFELONY IisD ] OPERATION DwARRANr/ ` ' .DTRAFFIC Du .v-DDv De.OVES DMINF - JL NO. ELOSITNE NtARRANi: bk.,Ow slate d Peaio DU, DUnenomei COUFr CASE ND. •I : IDS NO.. AGENCY CODE MUNICIPAL P.D. DEF. D NO. MOPE/ RECORDS AND D NO. I --D' :' OEFErU'Wfg STUDENT 1D NO. - GANG AC'TMTY RELATEDARREST g FRAUD RELATED ARREST J. NAYS, (LAST• FIRST, MIDDLE) - .. / ..:... _ �'(. �. 1;' ._ .. ,] a:a r�r .:..+5 .., e: - :: '�:f'�•:iik.',s.rsi::::. "ur:.<r':''n..t --e. '•- ,~• AtlASd 4 a .. STREET NAML - _. SIGNAL J ,.. ❑ Too 0 150 0200 ❑300 �400 ❑500 .. _ RACE. � _: �..: �..-., 40, SCARS, TATTOOS. SEX DFispar,L. H EIGHT FWR,COLOR � nic IJIT S HAIETH -�/ / 1 H .. '� ' •" GLASSES - FAf1AL hAi5 11 05 TE£TH.. (JP, UNIDUE PHYSICALAAPEA 1jLJ/y�Lon. Type, Desoiplion) . ., PPLAAeC+E-OF MTH.(C?Y.. a1F1CwWY1.—.:• 22 M - '((•/1•) R BLY MI PERMANENT ADDRESS (Skeet ApL Number) HOMELESS �0 UNKNOWN S/ CA 5 ©i�j_ ❑ BUSNESS OR 0 Sgi-IOL NAME AND ADDRESS .CO-C%c: _NDAN r NAME. (( ' FaS; mica) (Street) ic,Y) :(Sheet, Aa N�o ber) ❑ F-s. ❑ OR..D (State/Country) (Ls) COUNTS] '-'FL STATUTE NUMBER (Stale/Country) (21,) WEAPON SECED7 Type VIOL OF SECT r91`1 fPAT1ON ADDRESS SOURCE: 0 Verbal ❑ • OiYCU5T60.y ❑130NY_D_JUVEENIILE.__. ❑ LARGG . O Dv D MISD-7.1"c.;NOn CODE OF — UCP...fov ) -WAP.R:NT TYPE OR TRIAPFIC CMAT)ON" , . DAC Oc?•'tA.s. DEW DFw DPWDJWPU CAW ODvi/ 0war •' CASE t :. DAC ❑CA L S Saw D w DPW OJLN PU OAW ❑DVM' DwRi- CASE t: MEM DAC DCAFlAs Dsw DFw DPw DJW Pu DAW _. "- Erse. The 'O'eryr1d 5as and...es-the h e',e has just aid rector ie grounds to beae. sod dos befev hat the arose nam9d 'A_'sloat P.rnn - ... . On the - 'day �,.L 7 + ti' = . • Z0 0 .: 1 t 14-.. _ (HH_�!MM) a[ 91s• • ;�/• L�'E.�sr 1'y` five, be s�sc) 'HAT. EABOVE STATEMENT IS TRUEAND COR5EL17-' '• - Z74.6 {A\ SIGNATURE COURT IIDNUUMSt" <�ILOC- COD= !VII U O AGENCY NAME 0 HOLD FOR%30N63ir7XRING. DO NOT &OND' : ❑:I'understage;Ihst should I w5lfuky fail to ear before the ours as _ �_ �,�- required b ppear ttiat 1 may be Io&i it onterr t of . g - -ram, tAPpear:aCBond J•learrg). 000i y.ftas roles b a �'��; � c =.ie: �.n� owl' and a wSrrait for mY artest'sila4 be stied: Fivtheimore.I ..__ et -.ice::.. ze.r,. `-.-.:t: i; :. ethat'notice o rrel the time, dale. and place otal court SWORN (TG;AND.$b55CRT3ED a ME. •�� shard' be unt•Ic'the"atioCe 'address: I agree dial ink <.; �. ,��, n my rmponsnbility to notiry Clerk d the court (Jumbles tiles notify TFE UNeOIr�51GNe- s O?J,' T}1IS: �'� •tjnende Division) anytime Thar re, address dwges. - '7)1 DAY OF . You rood not a r in courtmust but �41Y M / /cc • Sigrv011 of Deaadant /JuveMe and Parent or r eylan =7 instructions cn the reverse side hereof. • 'Derrrny otthe DoieTar.uue_7y— rc 4. _ - gg■■�T�����yyyQ����..__..,. : INCIDENT NUMBER �� 1 .REPORT.SIGNAL 2 INC. DATE. ,2TIME DAYS] INCIDENT APT A 3 LOCATION/OF INNC.,IDEy 3 / ,6 7 I.6 Y ^J ' 4 DATE OF DISPATCH M1 5 TIM DISP. 6 0N,SC N.E__ 7 IN SERIICE 8 aNIT Cf.) - 9 PINA3''"'.^,l �-�''� OF 1.4 r� // ! /� �, .. 1( trcJ� 1 D PIN R' / REVIEWED BY - 11 OFFICER�AsSSAULTED _ ' YES yam•. NO `-- , n l tra'l 3_'�3'`3.' _2.' .CT � e ; �,; ,n ! �1 :a: •�_3 , : 12, TYPE OF OFFENS NCIDENT • ' � ' -(7 r E�IJ�j `n , Vrn rvci li [�L/V U(i 13 COPY TO , 14 CROSS REF INC. A' 15 INV. PIN 16 24 DESK PIN A' 17 TIME 5-' '6`, 6. 1 5) ' S� ) C? (_5_: LA ' . E 1�?"6: ��c6: '6�::5.1 F.: �I, 18 ATTEMPTED — VI.1 VI.2 �,• �I VL3 �` - - 19 FORCED ENTRY (structure only) ':_.YES _! IJO �' N/A 20 NO. OF STRUCTURES ENTERED ': -�' L�" 7 % (1) 7 7 �:: '_G , ��''�-• 21 STATUTE #1 22 STATUTE 42 23 STATUTE #3) 7� ( - //7 I _ :H :C' ;0) REFUGEE RELATED ; 9', •�.) (-1 •-K,'; . _ T.: 24 LOCATION TYPE 6': GAS STATION 'i`2• DRUG STORE/HOSPITAL '`e SCHOODUNIVERSITY '`5 PARK. LOT/GARAGE 7) LIOUOR SALES 13 BANK/FINANCIAL INST. "�9' JAIUPRISON ;26. HIGHWAY/ROADWAY 'a.:RESIDENCE-SINGLE ? BAR/NIGHTCLUB .14,COMI''ERCIAL/ fa, RELIGIOUS BLDG. :27. PARK/FIELD WOODLANDS F• 2': APARTI'AEIJT/COIJDO � 9 `BUFF RIdARKET OFFICE BLDG 2-1: AIRPORT • ;28LAKE/WATERWAY ',RESIDENCE -OTHER (10 DEPT./DISCOUNT 15!INDUSTRIAUMFG. 2 BUS/RAIL TERMINAL ;29 MOTOR VEHICLE q , ) HOTEUI OTEL STORE a, STORAGE 23, CONSTRUCTION SITE 30 OTHER MOBILE ��a-,0 CONVENIENCE STORE: SPECIALTY STORE `7, GOVT/PUBLIC BLDG. (24 OTHER STRUCTURE (99 OTHER KNOWN HATE MEDICAL DOMESTIC _ TOURIST DISASTER _: MDT _ GANG CRIME RELATED VIOLENCE CRIME.-) RELATED HIT RELATED . C: _L —' t'4' '0' L-' P' C-' 4) '— �d °--' i • CM -11 VICTIM TYPE JUVENILE ENFORC MENT ADULT • BUSINESS GOVERNMENT CHURCH OTHER WILL VICTIM PROSECUTE? .-_. CIVIL DISTURBANCE C. S-I f9 c _ VICTIM 41 ,� : .2.; , , 1 4: 41, 5 . 9'' `0 ` I VICTIM 42 _ :2 j : 3•f , 4 r='i 6 % •E. �. YES _ NO _.• YES •_I NO 2 NUMBER L —TI -�' ' Ul i"• Pay VICTIM 4'3 I. ' t'z 1 a) a , r5 6. 9; : YES - NO OF =J +(t2 ._J ,-- 3•' (p /ICTIM'S -. 67 Q. RELATIONSHIP UNDET ER. EX- CO- BROTHER. STEP. STEP. OTHER • TO OFFENDER NA MINED STRANGER SPOUSE SPOUSE HABITANT PARENT SISTER CHILD PARENT CHILD IN-LAW FAMILY 3 3 VICTIM s1 g @I L2 (03� @ii• @z' (D1 (IT (a5: (Q5) To) �i=1' 'T2. � O VICTIM ;�2 @91 (5oi; (02. DL-3` 041 (05; (0""6 (07: (O6' `9:- ;ii': '�2' VICTIMS Cr) I D ( ( 12 ! �; G +`� C.D. V, C/ : X —,`e , !� 3,7 ,i0) T VICTIM.#3 L: .1j (02. 'OS: (04l : (oo; (OZ. (08: OL-9; 90: fi; 'j• �• CHILD OF BOY, SITTER' LAND. 3 -c BOY/GIRL GIRL DAY EM- EM- LORD' ACOUAIN- C STUDENT TEACHER FRIEND FRIEND FRIEND NEIGHBOR CARE PLOYEE PLOVER TENANT TANCE OTHER .Z E' VICTIM 41 (f3' : !152 :16� !iT `81 C19• •20` ; y, ;22` rig, '-t VICTIM #2 i13.' Q) 11 ,1 s. •17) i. 8, 19' '�0, '2,�' ,-.2-2, 13, :a:'J U n `p L, )_7) '� LT.,' 0 ,Ciii' c� �;� VICTIM 3 /f3! a a, r-i . (58, (: ;20• (i: (:, `. 99: MIDDLE BUSINESS 1' . VICT. 0 2 LAST NAME, FIRST, "/ - VICTIM OF VIC DV P.R.. f /} r I DOMESTIC '- PAMPHLET •� PAMPHLET '- - .WfTN. f �jYTt�- ✓- I , 7 ';"'.�/ , VIOLENCE? c? GIVEN •;�; GIVEN ° A 3 7J ' A' _.J 4. • R/S ... '� ,5 .. DOB/AGE ` • . J J . •l .6.:. SS•=: I _ I _ 1 1 1 7 RESIDENCE ADDRESS /APT. # /CITY /STATE /ZIP /COUNTRY 8:- VICTIM OF''. 1 2 3 STATUTE.,. .; n .. ',� (E" •. 6 -RESIDENCE C! N/A 02: PART YEAR ., .; STATUS- .: 01-I FULL YEAR (03.1 NON•RESIDEN i 9A 'RESIDENCE - (p.9' N/A `?, COUNTY .YPB . . 01'• CITY !63: FLORIDA . ( ( OUT OF ITg' YF STATE wi 10 BUSINESS ADDRESS / S OOL / _ GF1Y / ZIP fj s 11 DAY/TIME AVAIL, '12 OCCUPATION/TITLE 13 RES. PHONE 14 -BUS. PHONE `---'.•�`. G f 1 VICT 02 LAST NAME, FIRST, MIDDLE /BUSINESS VICTIM OF VIC DV P.R. C C' C' 3 A/J A 4 R/S 5 DOB/AGE 1 -` I l�-/- ,/ ��� i �� { / I / 1 I DOMESTIC PAMPHLET PAMPHLET W(TN. �. ✓ f�� U�'Y� l� G_ 1 F"+� 1 -,� I .� f`? VIOLENCE? GIVEN (' GIVEN '¢','• '7 J .L/ ,,,1 if / ';. ✓1 _ 6 SS.`.' I _ _ I I / RESIDENCE ADDRESS /APT # /CITY / STATE /ZIP /COUNTRY ,ASS n 8 VICTIM OF 1 2 3 STATUTE ,er ;`! 8 RESIDENCE ' N/A (2; PART YEAR STATUS _.: FULL YEAR 6(-8'; NON-RESIDENT 9A RESIDENCE `l' N/A (Q2I COUNTY 2) OUT OF TYPE Et CITY DL'd' FLORIDA STATE �.., -".,, -= c 10 BUSINESS ADDRESS / SG+9D—OL CIFY / ZIP r`!t 1 `1-� 1)�i L� 11 DAY/TIME AVAIL. I./ � S % 12 OC PATION/T1TLE. v %d C 13 RES. PHONE ( ) 14 BUS. PHONE ( ) °i ) / ?k. 1 . VICT- 0 - - P.R. C.) ...`•?,,, WITN. (J • 2 LAST NAME, FIRST, MIDDLE /BUSINESS r-, VICTIM OF VIC DV%�- DOMESTIC �' PAMPHLET C' PAMPHLET VIOLENCE? C GIVEN N; GIVEN EI 3 A/J •--.) A ' •J 4 R/S 5 "DOB/AGE '% 6 SS.". I I �_ I _ 7 RESIDENCE ADDRESS /APT. A CITY / STATE /ZIP COUNTRY -;-,_ 8 VICTIM OF 1 2 3 STATUTE IJ 0 0STATUS 8 RESIDENCE (00) N/A 021 PART YEAR ; FULL YEAR 5) NON-RESIDENT 9A RESIDENCE (-10, N/A CO--21COUNTY (.0., OUT OF TYPE (Di) CITY (G?'' FLORIDA STATE 10 BUSINESS ADDRESS SCHOOL • CITY ZIP 11 DAY/TIME AVAIL. 12 OCCUPATION/TITLE 13 RES. PHONE 14 BUS. PHONE g; 1-- .EXTENT OF. INJURY NONE MINOR SERIOUS FATAL r VICTIM 41 0' () r 2 LOCATION ON BODY VI. #1 3 HOSPITAL/CLINIC SQUAD R VI. #1 _ V q81 := _ VICTIM 42 C' L! ) 0 VI. #,2 VI. -2 VICTIM #3 a1 at a) C VI. #3 VI. =3 •� = : 2.!-.INJURYTYPEl UN- SONS. •US5 NI .<,�"•-'-^ - N/A GUNSHOT STABBED LACERATION CONCIOUS BROXEN BONES INJURY VICTIM #1 � 61 . Q) m% �l r65 ��' VICTIM 42 CO) CO �' -'' ,4' a .." VICTIM 43 M �? DL'2i ..) co-4' 1155) a FINL LOSS CIA- 'SONS) TEETH BURNS 6RUISES OTHER la a(D=9; �9; 02, a 0% J DL7; (0-8: 0) 0' • ••: 1 1 PERSON INTERVIEWED ... ri 2 A/J 3 AGE 4 RES. ADDRESS CITY APT. R 5 BUS. ADDRESS RES. PHONE ( ) =.i�•'';. ... •1 BUS. PHONE ( ) ,x = _ PERSON INTERVIEWED 2 A/J 3 AGE 4 RES. ADDRESS CITY APT. 5 5 BUS. ADDRESS RES. PHONE :;f:.: BUS. PHONE ) (R j PLEASE DO NOT VJRtTE IN THIS AREA .� I0D0000000o0- 0000000 00D0 1 V • • is 111 IE ME W EI rr� 092 liEl ED▪ E 11131 m EOM L SD IEEE 1931 ZEE E▪ EO m! INDIND -oI cu • MEE 0 O) v. 5 II U I_ > 1 LAST NAME, FIRST, MIDDLE 2 RESIDENCE ADDRESS APT. ;< CITY .1 DE .. 3 RES. PHONE (' ) 4 BUS. PHONE ( ) NM P s Mc., E I I 4� "' T c 5 BUSINESS ADDRESS / CITY / LP CODE 6 USUAL OCCUPATION 7 INJURED ti ``•YES O: NO (7_, FATAL 8 CTTITF_NSHIP I o ;-;;'•"..^• Q n : YES, n 5 'NFO 9 NICKNAME 10 MJ 'A) CI 11 DOB/AGE 12 RACE/SEX 13 HGT. f 14 WGT. 15 EYE COLOR 16 H JR COLOR VI (rD N 17 CLOTHING, JEWELRY, MANNERISMS, CHARACTERISTICS 3 O cr #1 3 18 SCARS, MARKS, TATTOOS, DEFORMITIES: DESCRIBE A LOCATION OF BODY D fl- 0 -1 '1 LAST NAME, FIRST, MIDDLE J = et, , 5 M 2 RESIDENCE ADDRESS / APT. I CITY / ZIP CODE 3 RES. PHONE 4 BUS. PHONE 3 O • i P s 5 BUSINESS ADDRESS / CITY / ZIP CODE 3 3 ,E I 4 0 T G , 6 USUAL OCCUPATION 7, INJURED OYES I--': NO f; FATAL 8 CITVFNSHIP J rt S (_' 0 9 NICKNAME 0 G (D TES, A :JO o 10 A/J !� J 11 DOB/AGE 12 RACE/SEX 13 HGT 14 WGT. 15 EYE COLOR 16 HAIR COLOR C c :NFO 17 CLOTHING, JEWELRY, MANNERISMS CHARACTERISTICS , Y• �• #2 18 SCARS, MARKS, TATTOOS, DEFORMITIES: DESCRIBE & LOCATION OF BODY ,1 HAIR LENGTH ' 1i Q 1 - LONG .1-, r2,12.MEDIUM 'J �2_)3-SHORT a) 2'i4-RECEDIJ3 0` •`j 5 R41 r)ING 2 HAIR STYLE Li) r2)1 _ AFFt7N4J1JRfL 2) 2. 2-BRAIDED CI) 1-13- BUSHY Q 04-DIRTY/GREASY 3 FACIAL HAIR la) CT, 1 - CLE4NSHAVEN u 22-)2-FULL BEARD Q !2_)3-FU MANCHU Q 4214-FUZZ • 4 COMPLEXION 1Q (9 . LGHT �7_J 22-MEDIUM O `j3-DARK �:• CZ4•RUDDY 5 TEETH a`• 2' 1 - BROKEN Cf_i IT. 2- BUCK TEETH Q •:2)3-DECAYED �Tj ©4-DIRTY 6 APP/DEMEANOR r T r.2)1 - DIRTY :' : (2i2-FLASHY 'T;' 2;3-NEAT rf)i2;4-ANGRY 7 SPEECH CT, 2; 1 -ACCENT ? ri`2-RAPID (-1-) , )3-SLOW 2(7)4 - LOUD 8 R/L HANDED . 1 ' 2-;1 -RIGHT '1; :2-LEFT '`'r .2 3- UNKNOWN - �11216-RA( -- ',t, ® ?` 4m `:y < . . r� -w= D J 5 - DREADLOCKS (f)(,6-PROCESSED O C) 7-STYLED 0 2D 8 - UNCOMBED 0 29-WAVY/CURLY O r-2?)0-OTHER Q -I i 5 - GOATEE C 06-LOWER LIP ( Q 7 - MUSTACHE a., ® 8- SIDURNS Q U9-UNSHAVEN Q JO-OTHER a? CI) 5 - TANNED 006-MULATTO 07 - ALBINO CO M 8 - ACNE Q CZ) 9-FRECKI Ff Cij 2i0-OTHER • a';J 5 - GOLD Qt?)6- GOLD UNED `U —2� 7 - GOLD DESIGN Li' © 8 - MISSING Li`. 2',9-VERY WHTfE a) MO -OTHER rf''. `; 5 - CALM O�2J6-COCKY :T 12 17 - DRUNK '-f-I 8- NERVOUS 'il ©9-VIOL ENT ') CD0-OTHER t 7 :CL 5 - SOFT Cr) (2)6-LISPS `I r2 07 - NASAL r✓i`.• :' 8 - RASPY ta-.) Cr; 9 - STUT1TR `T-) UO-OTHER 9 BUILD 11) 1 - LIGHT ..� ,22-MEDIUM I.?,'• :2j3-HEAVY ' - 1 ' MISSING PERSON CODE -.. ®��".,.��.._:-�:.�:,•2��,;TYPE1!'1tS57NG... Q..2 1 - MISSING s 1,7 IT Cam., 2 - RECOVER DOT MISSING . ®� 2 � 3 - MISSING AND RECOVERED c 5?I �. .. Q �) 1 - RUNAWAY r (7; 22 - PARENTAL 2 2 �0 CZ-.) 3 - INVOLUNTARY 'Ji C 'J 2J 4 - DISABLED (i' CZ , - �,* •- � � 1 - ENDANGERED 2 - DISASTER VICTIM 3 - VOLUNTARY ADULT 4 UNKNOWN �3 .RECOVERYTNFORMA770N. . I0 G 0 - N/A '0 2) 6 - RETURNED TO L l �2� 1 - VOLUNTARY 0 J PARENT/GUARDIAN ,J C; 2 - LOCATED -NOT LT, `) 7 - DECEASED RETURNED 1I 9 - OTHER ®N-4.:FOUL. PIAY.SUSPECTED?_ '; 1!5 ,PERSON MISSING: PREVIOUSLY? ® y_ �:' Q2 1 - YES Q C• 1 - YES Q O2 2 - NO Q G 2 - NO . © M 3 - UNKNOWN ,0 a,3 - HOSPITALIZED CI 0 4 _ HRS CUSTODY C) (7) 5 - LAW ENFORCEMENT CUSTODY - :1-%!EHICLE�;-©STOLEN 0'SEI%ED FjFAILED TORETURN ,kji ;.. --,.: ).CODES;'r` P.O. ABANDONED a..) REC'VD FOR OTHER AGENCY ) MPD STOLEN "`'`"` ":. -`I IMPOUNDED ® RETURNED TO OWNER CO OTHER (ARSON/DAMAGE) USED IN CRIME Q VICTIM/LARC OR Ai -ATT 22 (IF DAMAGED, USE AND/OR RECVD "0"). .2 VEiICLEJVESSELTYPE.,:.`:;:.;:': CVAUTO 0' CAMPER/RV BOAT C' TRUCKNAN v BUS a3 i AIRCRAFT Cr::MOTORCYCLE C6) TRAILER 0) OTHER - 3 VIN # / HULL # 4 DECAL;= 5 HOW WAS VIN/HULL ACQUIRED? . b 6 MAKE 1 7 MODEL Mei 8 YR. 1 9 BODY STYLE 10 LIC. #/TAG SNEcSSEL REG. 111 YR. 12 STATE =., _ 13 VEHICLE COLOR / v E- COLOR COLOR RANGE 114 SPECIAL CODE VEHICLE FEATURES / FEATURE TOTAL # OF VEHICLES .4.. . TOP BorOJ4 TOP 9or0M •® 1Q 1Q BLACK ©� �'� RED/MAROON ) LEVEL ALTERED T) DAMAGE TO REAR 0,.: © 2Q DARK BLUE a) (J) PINK . ',,3 13 j LT. BLUE/AQUA/TURQUOISE © r3) BEIGETrAN (0 ® DARK BROWN TS © WHITE - ® CJ LT. BROWN/BRONZEICOPPER 1-4) YELLOW : .0 O PURPLE a) to ORANGE/GOLD • ® Q DARK GREEN �9 99 OTHER/UNKOWN _ ® ' LT. GREEWLIME/OLIVE �3 . ® GRAY/SILVER 1?;• a) ® sQ STICKER/DECAL ON BODY/BUMPER .) DAMAGE TO SIDE 3Q STICKER/DECAL ON WINDOW lit BODY PART(S) DIFFERENT COLORS RUST OR PRIMER SPOTS ( ) VINYL TOP ® PAINTED INSCRIPTION ON BODY rl EXTRA ANTENNA(S) OR MIRROR DECORATIVE PAINT © SPECIAL RIMS/TIRES®® ) MISSING PARTS T) LOUD MUFFLER WINDOW BROKEN B) OTHER/DESCRIBE BELOW DAMAGE TO FRONT .Q 2 2 ) ) 0) 0: ) ©, Q.0 9C. 15 ADDITIONAL DESCRIPTION 16 TAG COMES BACK TO: NAME, ADDRESS, STATE, ETC. L)7 Y1 s. s-s - Z-� 9fl ■ . , 17 DOORS LOCKED? .OYES ONO 18 WINDOWS CLOSED? OYES /--, NO 19 KEY IN IGNMON? .OYES QNO 20 FINANCED BY 21 DATE OF LAST PAYMENT 22 INSURANCE COMPANY 23 PERSON LAST DRIVING VEH.. - 124 R/S 25 DOB/AGE - 26 RESIDENCE ADDRESS (ZJP) PHONE 27 BUSINESS ADDRESS RIP) PHONEC. 28 .LOCATION OFffECOVERY OF M.V. sy 29 RECOVERY MILEAGE 30 STRIPPED? OYES Q NO 31 DISP.- R IN OF VEHICLE ''D TOWE4 © OWNER 32 TONDTT7 _ r�.x ,,,,, � QN ©GOOD ®POOR >?,.s" ® FAIR Qs STRIPPED 33 VEHICLE TOWED BY/WHEERE? 34 IF 007 RECOVERY - MSG. # AUTHORITY RS:1;�'_iD=REQUESTED?."' O0 „Y�•;�,,,..,;,..-YES NO� 2 SCENE PROCESSED?SCENE?^ YES 0 NO 3 WAS PHYSICAL EVIDENCE OBTAINED FROM THE 0 YES LJ NO _I ) 4 LATENTS . 0 YES 0 NO 6 EVIDENCE TO 0 YES 7 ID TECHNICIAN PIN # UNIT # 8 FIRST OFFICER ON SCENE PIN # UNIT # MN E: 5 PHOTOS .OYES. .' NO PROPERTY UNIT .... YES l/ 77 -;DRUGAC7NTTYt,- _2_` ri;iT = "� N/A ® DISPENSE/DISTRIBUTE R1® BUY ® MANUFACTURE/PRODUCE/CULTIVATE © DELIVER .,) POSSESS ,3, USE ® SMUGGLE �.a...7. .r-_ - n',i - 1� - :I ... ._ :: ®SELL Q TRAFFIC () UNKNOWN Q OTHER ORUGT ..:: z ._..,�1l _ - T a. .,- s .- 1= . .- A .: G N/A Q HEROIN ®PARAPHERNALIA EQUIPMEtJT (Al AMPHETAMINE 0' HALLUCINOGEN ® SYNTHETIC 0i BARBITURATE ' 0 MARIJUANA © UNKNOWN © COCAINE © OPIUM/DERIVATIVE OTHER O�^ ):3.5,.1.•eta='��,i. Rom .:A`ic�'' .Ris4 t;: r"NA`r,,a-"1'�:.•'.o�' .,,�SOYAg r 0 Q n 0 n O 7 747 1 ENTRY s `3( FRONT REAR SIDE DOOR WINDOW . •-3; SLIDING DOOR •-21) DUCT/VENT 5 : ADJ. BUILDING ROOF 7; WALL 6 GARAGE DOOR OTHER/UNKNOWN EXIT ;0 ;a0 2 PROPERTYTARucTS Cr)) BUSINESS MACHINES BEER/LIQUOR 3` CIGARETTES : CKS/CHECK MACHINES 5.' CLOTHING ) : fi) ELECTRONICS (7; FIREARMS 3; cc FOOD JEWELRY f0. TOOLS (99 OTHERS C I c' BURGLARY ELEMENTS CD CL 15 n' ALARM INOPERATIVE '2 BURGLURIZED DURING LAST 12 MONTHS ! 3.. ADMITTED STRANGER OR TRADESMAN DURING PAST 7 DAYS (RES. BURGLARY). '"T' TELEPHONE SURVEY, UNUSUAL CALLS, WRONG NUMBER, HANG-UPS DURING PAST 7 DAYS •?: TENTED. UNDER CONSTRUCTION (g; SAFE OPENED/ATTEMPTED S; OTHER 3 METHOD OF BREAKING L - BREAK/CUT GLASS 2. BREAK/REMOVE DOOR PANEL CUT/BREAK LOCK CHOP/SMASH 3) CUT/BREAK SCREEN • HID IN BUILDING • KICK/PUSH S' PICK LOCK 9: PRY/JIMMY :1b REMOVE JALOUSIE •�1: REMOVE AIR COND./FAN (12, REMOVE WINDOW/DOOR 13SMASH GLASS -TAKE MERCHANDISE ;1.1' UNLOCKED/NO FORCE (99 OTHER 7 BURGLARY ELEMENTS 1 ATE/DRANK ON PREMISES (2; BROKE INTO COIN OPERATED MACHINE "..1:( BURGLARY NOT COMPLETED .S) DEFEATED/ATTEMPTED TO DEFEAT ALARM •. ) DEFECATED ,ISD DISTRACTED VICTIM CO IMPERSONATION 16J KNEW LOCATION OF HIDDEN CP.SH LEFT TOOLS ON SCENE `0 MALICIOUS DESTRUCTION . . ("Ili NEATLY SEARCHED 4 INSTHUMENT USED 37, BOLT CUTTER J. BRICK/ROCK :3' CHANNEL LOCKS' VISE GRIPS 1 • CHOPPING TOOL 5 CUTTING TOOL 6". CUTTING TORCH "7 FEET HAMMER KEY 10 PRYING TOOL fi SAW/DRILL n SCREWDRIVER 53• TAPE s4 VEHICLE (99 OTHER i2 PIGEON DROP 113: RANSACKED ENTIRELY '1.4. RANSACKED PORTION ( REMOVE PRINTS/WORE GLOVES •6: TRICKERY '57' TRIPPED ALARM AND RETURNED LATER rf8. TURNED LIGHTS OFF -ON ("9. USED TOOLS FOUND AT THE SCENE OTHER 6 TYPE OF PROTECTION .i LOCKS 2 BARS :3 SILENT ALARM ;4.. AUDIBLE ALARM LISTENING DEVICE b l MOTION DETECTOR 9 • OTHER 9 CRIME SCENE INFO. ID REQUESTED? YES -NO IF NO EXPLAIN WHY . � .' SCENE WET ALREADY CLEANED BY VICTIM 3:. SURFACE NOT CONDUCTIVE TO PRINTS CONTAMINATION EXPLAIN IN NARR. 10 VICT1M WAS �i HOME ' 3. VACATION (/: WORK '1•• GONE TELEPHONE CD CALLED VICTIM (BEFORE/AFTER) (2 : PULLED OUT CORD i.1". SUSPECT USED VICTIM'S PHONE 2 SUSPECTS ACTION (ROBBERY ONLY) 1) ASSAULTED VICTIM 1 I/ SEX ACT INVOLVED ASK FOR OR BUYS MERCHANDISE IL SHOTS FIRED � A.POLOGE T IC `2' USED LOCKOUT LIDDEMANDED JEWELRY a')D ) USED MASK ,�) MADE THREATS S 1r_4: USED NOTE 3 VICTIM IS (WAS).41 ABOUT TO ENTER HOME l� INTOXICATED (2. ALONE . 6) OPENING/CLOSING BUSINESS ' 3., ELDERLY V°) RETARDED . GAMBLING '" S.. OTHER 1: GOING TO BANK -1 ti t gt _ CO USED CORD TO TIE VICTIM . a, OTHER `6i OTHERTHEFI INVOLVED • 5 USED STOLEN CAR r7, PRODTITUTION INVOLVED ..M.:. OTHER 1 HANDICAPPED - V F - ) PURSE SNATCH :"9j PUT MONEY IN BAG 4 FORCED VICTIMS TO r) DISROBE !zj ENTER CAR TRUNK _ , G ENTER RESTROOM • GET MONEY FROM BANK, FAMILY, ETC. sue. GO TO ANOTHER LOCATION LIE DOWN 1 C OPEN SAFE 5 FORCE USED ON VICTIMS CID ABDUCTS (12.CUT/STABBED VICTIM BLINDFOLD VICTIM l P : GAG VICTIM 3Q BOUND VICTIM (7--) HIT VICTIM BIT VICTIM i1OI SHOT VICTIM Q COVERED VICTIM'S FACE 11 THREATS ONLY 67 CHOKED VICTIM GI OTHER 6 IMPERSONATED -0 CUSTOMER ,_a% RENTER r2' DELIVERY PERSON `I REPAIRMAN a% DISABLED MOTORIST ,1r3: SALESMAN DRUNK 13: SEEKING AID a) EMPLOYEE/EMPLOYER CO SOLICITING CC FRIEND S' SURVEYING (7) INJURED (E,g, OTHER C .'' () PUT PROPERTY IN SACK lj POLICE/LAW ''on 1 REAR OF BUILDING IM RELATIVE F _5-. 7 SOLICITED, OFFERED _1f `_) AID FOR CAR 17 GIFT/PRIZE -- •a) ASSISTANCE/INFORMATION MONEY %'"" �3 CIGARETTE r91 PROSTITUTION/SEX p CON GAME l70) RIDE A a, DRUGS a) USE OF PHONE J FOOD, DRINKS, CANDY L) OTHER 8 CHARACTERISTIC OF SUSPECT (SEX CRIMES ONLY) (17 ANAL SEX 17 ORAL SEX L'12) UNUSUAL ODOR (BODY ODOR, ( APOLOGETIC `9; MASTERBATED SMELLED GOOD, ETC.) 17 CHILD MOLEST `0, RAPED MORE THAN ONCE -G) USED LUBRICANT aQ. EJACULATED 111 RIPPED/CUT CLOTHES (IS) USED VICTIM'S NAME a` FOUL LANGUAGE ri2: UNABLE TO ACHIEVE: VIOLENT © GENTLE ERECTION 09 OTHER (7 MAKES THREATS *. q STATUS TYPE' :'.. CO FORGED C+ COUNTERFEIT FORGED AND UTTERED7' COUNTERFEITED AND UTTERED T CHECK -3-) MONEY ORDER `) ATM/DEBIT CARD 1 PRESCRIPTION v1• OTHER ;'. TYPE--•C) CREDIT CARD 1M BOND/CERTIFICATE /� IDENTIFICATION'' TRAVELERS CHECKS :' CHECK CRIME SCENE SPECIFICS '•' 1 CHECK NO. .; ti 2 AMOUNT 1.CAN OFFENDER BE IDENTIFIED? C' YES O NO 2.OWNER OF CHECK NOTIFIED? C) YES Cl NO 3 CHECK PAYABLE TO 4 DATE OF DOCUMENT IF YES, NAME a' 3.THEFTVERIFIED? 0 YES Q NO 5 BANK DRAWN ON 6 SIGNATURE ON IF YES, CASE NUMBER P.D- kr- ':t FACE (MAKER) 4. WAS OFFENDER ENDORSEMENT OBSERVED? 0 YES 0 NO 7 ACCOUNT NUMBER '=' ,_ 8 OWNER OF CHECK (PERSON OR COMPANY) 5.WAS OFFENDER(S) PHOTOGRAPHED? Q YES Q NO 6. FORGERY AFFIDAVIT OBTAINED? Q YES CJ NO , E TYPE OF IDENTIFICATION USED 7.HAVETHE ORIGINAL DOCUMENTS BEEN PROTECTED FOR EVIDENTS? . 9 DRIVERS LICENSE # 10 STATE 0 YES ✓ NO WHERE? CREDIT CARDS -',' 11 OTHER I.D. (DESCRIBE, INCLUDE 5's, PHOTO I.D. ETC.) 12 COMPANY NAME 13 CARD NUMBER 14 ISSUED TO ■ ■ ■ ■ ■ ■ ■ Ell ■o ✓ 2▪ 2 rm SEE 139 113211 6111 NEI ISM 1691 EMI ZIEZ ['1 QD O OFFICER KILLED FELONIOUS in OFFICER KILLED ACCIDENT OR NEGLIGENCE a) OFFICER ASSAULTED, NO INJURY G` OFFICER ASSAULTED, MINOR INJURY O OFFICER ASSAULTED, SERIOUS INJURY 3 TYPE OF ASSIGNMENT: . ONE PERSON, VEHICLrE, ALONE 0 ONE PERSON, VEHICLE, ASSISTED Oj TWO PERSON, VEHICLE DETECTIVE OR SPECIAL ASSIGNMENT, ALONE 5; WAS OFFENDFRINJURED?:;:':-• [_I EXTENT OF INJURIES TO OFFENDER 1' N/A . -.(1)jT MODERATE (a MINOR 0) SERIOUS §;:OFF10EiF3�EJCP„ERIENGE (1N, Y'>:.)XR$),'.� 'OFF1.9EP ACTIVITY rfl RESPONDING TO DISTURBANCE (31 BREAKING AND ENTERING IN PROGRESS OR PURSUING B. AND E. SUSPECT in ROBBERY IN PROGRESS OR PURSUING ROBBERY SUSPECT '-) ATTEMPTING OTHER ARREST , CIVIL DISORDER a) DETECTIVE OR SPECIAL ASSIGNMENT, ASSISTED .0, TRAFFIC/MOTORCYCLE OFFICER OTHERALONE OTHER, ASSISTED YES O NO UNK. C2+ FATAL PIN DOMESTIC DISTURBANCE HANDLING, TRANSPORTING, CUSTODY OF PRISONERS INVESTIGATING SUSPICIOUS PERSONS OR CIRCUMSTANCES AMBUSH, NO WARNING ASSAILANT MENTALLY DERANGED TRAFFIC PURSUIT OR STOP OTHER 4 -(ANSWER ALL QUESTIONS Y N UNK N/A WAS OFFICER WEARING BODY ARMOR? 0' t_- DID ARMOR PREVENT SERIOUS INJURY OR FATALITY? 0+ 0) WAS OFFICER AWARE OFFENDER HAD WEAPON? DID OFFENDER USE OFFICER'S WEAPON? WAS A FIREARM DISCHARGED BY OFFENDER? DISTANCE FROM OFFICER IN FEET (ESTIMATE) O O O. WAS A FIREARM DISCHARGED BY THE OFFICER? U,..:: twJ .:s.: vrrw..tn....... .tU,t17;.VF,- N1-1 M/5U5Ytl:'1;3'.:... .:. , -. :i5- © , O Cr^'' OO PROP- S - STOLEN R - RECV'D FOR H -RETURNED TO OWNER E - EVIDENCE/SEIZED CODE F - FOUND OTHER AGENCY K - PHOTOS TAKEN PROPERTY Y - MPD STOLEN 8 REC. D - DAMAGE (INC. VALUE) P - PERSONAL RETURNED TO OWNER A - ARSON (INC. VALUE) 1 PROPERTY RECEIPT •?-_� 2 ...''.;�.' PROP- •- CODE 3 VIC S 4 5 TI DESCRIPTION OF.ARTICLE O.UAN. SERIAL #, MODEL, BRAND NAME, ETC. 6 VALUE PROP. CODE 3 VIC S 4 QUAN. 5 DFP'RIPT70N OF ARTICLE SERIAL *, MODEL, BRAND NAME, ETC. 6 VALUE �a amisis -- I 1 T 3t1 SWVEAP9N7','PEU5ED. t 76 iiN. r .; ✓' ®, QP DO - N/A O O 06 - BLUNT OBJECT O 012 - SIMULATED r O 0 01 - HANDGUN O 20 07 - HANDS/FISTS/FEET 0 0 13 - DRUGS .'®O 20i 02 - RIFLE 0 0 08 - POISON lQ M 88 - UNKNOWN O ©03 - SHOTGUN 0 0 09 - EXPLOSIVES 0 0 99 - OTHER OE O O 04 - FIREARM • O 0 10 - FIRE/INCENDIARY (NARR.) -O 0 05 - KNIFE/ O Q 11 - THREAT/INTIMIDATION 2 WEAPON FEATURES O T.)01 - CHROME/NICKEL O a)07 - DOUBLE BARREL O CZ) 13 - LG. BORE lO [ii? 02 - BLUE STEEL `1I) as 08 - SINGLE BARREL O 14 - SM. BORE 0 o 03 - AUTOMATIC '3 i 09 - SAWED OFF `i' 2) 00 15 - OTHER 0 Q 04 - REVOLVER `i i CJ 10 - PUMP DESCRIBE O V 05 - SHORT BARREL O 0 11 - BOLT ACTION 0 (2D 06 LONG BARREL O O 12 - ALTERED STOCK =:' CU-rING INST. - •.3 CALIBER/GAUGE Irate 7 4 MAKE 5 SERIALS 6 BARREL LENGTH 7 MODEL 8 COLOR 9 TYPE OF GRIPS 10 BUTTS i� V S in -�a:il ; / MN/ , /-7-9 a ,�,�' .� ,.) is 5-7-cy1 'tig.(. -C l) ' if-J7— `701. 1 F iaezICA-Zo S -e- . :::,3- 2Z-`7.1 L:. 2) Z 70, 1 6 $ y`` .:.$•-3-`J0 ,:- - 7 J`- -r'-ie- S-r av s 0-6- % 0 1/W�' 17V DYqYg s Sl-y` :. A--- ub-g' Pi 19-,- - e ,i/i i' °,' c C'Ul � T,,,R Cif-�1, ✓ io-'/ ;c1 Li' S` Jr✓ — `v-?e-- A_ jl .. = (%jam 'v u5 5T Y >JS D,,elvf r i f f v-PT Jc V1 vi - , . ( i-4 `'h3_f,1 ' (-.1 ------77'...i.T .7 ). -} i ff st- 1-4-7-)-1 A o'-rc .07i . i tv ! "'t7. s : Mark Reflex' byNGS EM-154334-2:1312111098 GS03 Printed ih'U.S:A:�:` e ,%�. � ;'' ° {1.�'''- < s� PLEASE OO-AJOT WRITEJNTHIS�AREA - EI® ti ''' O® � � as . ' „ s � ' �82O •-,•,. ."Z x `4-i- �_� a � 0 0 -�� 1 ! ==�x—__•_. `Ii__._._ ...r.;. 7�. _•�Y__ ���:e- s ,__._ i�. f;.� �i -... -.. 1 4 ..-__....? ._,.. * I ....._ ..... zt.._.,, .�+..- �-?. I MIAMI POLICE DEPARTMENT "INTOXILYZERt 400" BREATH TEST CHECKLIST Subject's name Last: First : ,7- .' g3" Middle initial Gy. S) veT)�rJ Test date: to-7-07 Time of first observation: oz(fs- CCR#: i zs 99 Test Time: 03V5- 03-b� - Instrument Serial Number o7 72?s Test Number: h_% OPERATING INSTRUCTIONS (check off each procedure as completed) 1. 7 Switch Device on 2. Follow Instructions on Screen 3. Attach Mouthpiece r 4. Instruct Subject to Blow 5. Take Sample 6. Record Reading 0. 08 G210L 7. Discard Mouthpiece _ 8. Switch Device Off 9. Wait Two Minutes 10. Switch Device On, Follow Instructions on Screen 11. Attach Mouthpiece 12. Instruct Subject to Blow 13. Take Sample 14. Record Reading 0. 0 a 1 G210L 15. Discard Mouthpiece 16. Switch Device Off Operator's Name/Printed Tee Signature ID Number "INTOXILYZER 400" BREATH TEST CHECKLIST 'Submitted into the public record in connection with item DI.1 on 01-28-10 Priscilla A. Thompson City Clerk :1 F.H.F0P.D. 0 S.O. tj OTHER JflfVOENCY Di DAY OF fx5112,1 7 67 D P.M (P"ri) LTYPV).834DDije^ STEADY -I n5112 crnk)&<54fEdtiWt 1.1C1O4S.E NO.. • STATE OF FLORIDA DEPARTMENT .OF HIGHWAY SAFETY AND MOTOR VEHICLES • DIVISION OF DRIVER. LICENSES NOTICE OF SUSPENSION "n2'n-Y "9-en V17-‘ CTrY111' /r7? --019 7.SATRZ. r-obAtire'V'ity'rr'h 5-gs DAY leyolii217 mi AfeVit-N) 1-4°4,2WR• YIL.19.9 OCR ' yELEPHONENUMBEA EFFECTIVE THIS DATE YOUR DRIVING PRIVILEGE IS SUSPENDED • FOR.: • • BEING UNDER THE AGE OF AND DRIVING OR IN ACTUAL ;PHYSICAL CONTROL OF A MOTOR VEHICLE WHILE .HAVING BREATH ALCOHOL LEVEL OF 0:02. OR HIGHER. THIS SUSPENSION IS FOR A PERIOD OF 6 MONTHS FOR A FIRST :-:VIOLATION, OR FOR A -PERIOD OF 1 YEAR IF PREVIOUSLY • : ' SUSPENDED FOR DRIVLNG OR BEING IN PHYSICAL CONTROL •OF AMOTOR VEHICLE WITH A BREATH ALCOHOL LEVEL OF . 0.02 OR HIGHER: /7 f/ BREATH ALCOHOL LEVEL if L., 1-1 • •. .• 1,1• :.REFUSAL TO SUBMIT Tp A BREATH TEST UNDER E S. 322.2,616. :" :•• ..THIS SUSPENSION LS FOR A PERIOD OF ONE YEAR IF THIS LS THE FIRST REFUSAL OR 18 MONTHS IF -PREVIOUSLY SUSPENDED FOR • ...REFUSAL TO SUBMIT TO A .-BREA_TH, BLOOD OR URINE -TEST: NOTICE WAS R4.ND DELIVERED TO DRIVER ON DATE License Surrenclered4 Yes allo, . .Ejigibie for permit?: Yes :9 No • • • Unless ineligible, this suspension notice hJI serve as a temporary driver's liCense and ....1:o41eiPire at 'midnight on the 10th day following the date of the issuance of this notice.- •This permit becomes effective after 12 hours have .elapsed from the time Of, issuance•of this notice. .. • • ' .At the rel) /1Yt• • DHSMV hearing office, you may request, •withis 10 calendar days•after the -issuance of this suspension notice, a review of the suspension by th arent ofHighwa Safety aurl.Motor ve tes. (See reverse side.) • OF DRIVER F OFFICER BADGEg LD TROOP/UNIT .'TA,MTE-DHsiery HEARING OFFJCER PINK-OFFICER:AGENCY COPY . • . • H.SMy 781: 03 (REV, 59/05) . YELLOW -DRIVER'S COPY Submitted into the public record in connection with item DI.1 on 01-28-10 Priscilla A. Th3cnpson City Clerk. SIGNAf JRE'•OF NOTARY PUBLIC DATE REATH TEST RESULT AFFIDAVI i FOR UNDER AGE 21 SUSPENSIONS STATE OF FLORIDA COUNTY OF /y1I J ) • 1/1 ei)Af kiP H ereby.swear or affirm that I tlmiriistered a breath test to ‘3.—Prtrif55,S is G�r!?< XirY, .;DiiverLicense No. i ! 7 367 -- fl y 11 � ypl( , accordance with s. 322.2616 F. S. The first breath sample was collected on la-1 0 f at 173 , resulting in 0 (date) (time) gains of alcohol per 210 liters of breath (g/210L.). The second reach sample was collected oniti'/ZC%at 0301. , resulting • `(date) (time) iia 0:' / g/210L. .he -breath test device, used, 2,-ArVp)t `I,, .Z y 1(name) . .. .(7N 17 . ,. is listed in the U_ S. Department of (Serial No.) mn ortaaon's conforming products list, and 11as:been calibrated >ed in accordance with t`le manl cturer's and/or agency's matting statement THIS AFFIDAVT.T.M1IST'BE NOTARIZED OR ATTESTED TO:, ;S. U710] ._-Th_:forego f instvment tivas sworn to and l ribe. ore me- 4 ..: t� ' STING OFFICER Cyr TITLE 'fp• I4-7—O9 OTE:14ai! or hand deliver to the designated Bureau of Administrative Reviews office, eliaitirient of Highway Safety & Motor Vehicics,>with:the notice of suspension., .. AII1DAVTT OFPROBABLE CAUSE STATE OF FLORIDA , COUNTY OF ,'j /Y•• -fW IlOft1715 ) 1, /p ciel-4€ ^ V -i , hereby swear or affirm tha YQQ l have probable cause to: believe that ,f (77.6,.,. S was on /n ?'tqunder the age of 21 as determined by the following Driver License ❑ I.D. Card ❑ Other: , and was driving or in'actua] physical control of a motor vehicle in this state with any blood alcohol or breath alcohol level or while under the influence of alcoholic beverages, to wit: (AFFIX SEAL) Page_of :ik3L ; •AwENF CEMENT OFFICER TRLS AFFIDAVIT MDST BE N07 ;RIZED OR ATTESTED TO The foregoing instrument as le •Tn oa re r• instritiaeht vias sworn to and befo n this day of ' abscnbedi fore me. - 20C Who is personally known to me or who s . -. produced ' as idcnfification. IGNATURE OF ATTE • TITLE 4Lc..1 e•• SIGNATURE OF NOTARY PUBLIC • DATE j EC NOTE: Mali or hand.dcliver to the. designated Bureau. of Administrative Reviews office, Department of Highway Safety & Motor Vehicles, with the notice of suspensibri. Submitted into the public record in connection with i item DI.1 on 01-28-10 Priscilla A. Thompson City Clerk 9 2 INC..DATE TIME / DAY /i�-7_i7C 44Q OF DISPATCH 5 TIV1 DISP. IN �' / OFFICER 12 TYPE O OFFENSE�N"CIDENT 18 ATTEMPTED COMMITTED — VI.1 ® VI.2 '_.� VI.3 i, 21 STATUTE 41 77 l - l % 24 LOCATION TYPE T: RESIDENCE —SINGLE T. APARTMENT/CONDO 3, RESIDENCE —OTHER `) HOTEL/MOTEL 5: CONVENIENCE STORE 1 VICTIM TYPE 3 VICTIM'S RELATIONSHIP TO OFFENDER Pf VICT- P.R. _ WITN. . L] SS'' 6.' GAS STATION 7; LIOUOR SALES 4* BAR/NIGHTCLUB 9 SUPERMARKET (10. DEPT./DISCOUNT !INDUSTRIAL/MFG. STORE STORAGE 51:SPECIALTY STORE (7 GOVT/PUBLIC BLDG 13 COPY TO 6 ON LOCATION OF INCIDENT APT, -v 4l/ 7 \) REVIEWED BY 14 CROSS REF INC. 4 7 IN SERyICE rI l 15 INV, PIN 4 19 FORCED ENTRY (structure only) ` • YES _.' NO . 4a, N/A 22 STATUTE 42 VICTIM #1 VICTIM #2 VICTIM #3 VICTIM #1 VICTIM #2 VICTIM #3 VICTIM #1 VICTIM #2 VICTIM #3 BNCT�� 11 OFFICER ASSAULTED `.' YES CP NO 16 24 DESK PIN 4 17 TIME 120 NO. OF STRUCTURES ENTERED DRUG STORE/HOSPITAL '`8• SCHOOL/UNIVERSITY 3. BANK/FINANCIAL INST. :19' JAIL/PRISON ;74,COMMERCIALJ 120 RELIGIOUS BLDG. OFFICE BLDG. 21:AIRPORT LAW JUVENILE ENFORCEMENT l 2) l ' 1) 0 ADULT - L3/ GE UNDETER' NA MINED STRANGER SPOUSE 00' (5) ro2: (o: CHILD OF BOY' BOY/GIRL GIRL STUDENT TEACHER FRIEND FRIEND ria' , 4': ,, 5, `6', LAST NAME, FIRST, MID DLE BUSINESS BUSINESS 4: R2: BUS/RAIL TERMINAL (33 CONSTRUCTION SITE i4.OTHER STRUCTURE GOVERNMENT /5) i5; E%• CO - SPOUSE HABITANT C 0(5; G. osl 54) g5; FRIEND 1-71 (17 7 RESIDENCE ADDRESS NEIGHBOR T8 CHURCH BROTHER PARENT SISTER CHILD 05: 07. (ILE: L. ,Ti0L, L/ 0:7) Via' SITTER' DAY CARE 1-g; v' EM' PLOYEE rT (20' EM. PLOVER fJ. 23 STATUTE 43 25 PARK. LOT/GARAGE .26' HIGHWAY/ROADWAY `7 PARK/FIELD WOODLANDS ;28. LAKE/WATERWAY (9 MOTOR VEHICLE OTHER MOBILE (:9. OTHER KNOWN OTHER g.T 9) gl STEP PARENT Y09. (09:• LAND. LORD/ TENANT ,2D .22) WILL VICTIM PROSECUTE? YES _ NO YES NO YES `.• NO STEP. CHLD 1-0; �I ACOUAIIJ. TANCE (3 �l VICTIM OF VIC DOMESTIC ✓ PAMPHLET CD VIOLENCE? ( GIVEN )J3 /APT.4 /CIT( IN-LAW rf1: /11: -11; OTHER FAMILY (13. OTHER DV PAMPHLET `Y) GIVEN /STATE / INCIDENT NUMBER 3 / .6' Tie cc, a 5-'C.S'l5.':5?Cs) 15. 5}C4, "�71T7'(71• 67; REFUGEE RELATED HATE CRIME MEDICAL RELATED DOMESTIC VIOLENCE • J. TOURIST CRIME DISASTER RELATED MDT HIT GANG RELATED. CIVIL DISTURBANCE (—, r-, CT- 2 TOTAL NU NIB ER OF VICTIMS 3 A%J J /ZIP 4 7/S n 5 DOB/AGE '. S73 /COUNTRY 11 >m i9 i.. 9A R�SIDcNCE 132+ COUNTY IR; OUT OF _ 0 ' FLORIDA STATE V 10 BUSINESS ADDRESS S OOL �.G}TY ZIP 11 DAYTI1ME AVAIL 12 OCCUPATIONIITTLE/ 13 RES. PHONE 14 BUS. PHONE y y G 7 CO/ 7 �1 � % 1 � V '✓ 1 i J -j �- 7 fe"J-3 ;' ( ) ( ) / / / e ass 11 — Vl.1 C) VI.2 C 1 I I 10 PIN4 V I.3 _8': VICTIM'OF' . ` 1 2 3 . B',RESIDENCE.• •• • �' N/A 92; PART YEAR c - 'Oa:: N/A y.STATUTE::; a r-) (� STATUS`:> . pig FULLYEAR t)31 NON-RESIDENT • ,TYPE'': 5) CITY 1 VICT. Cj 2 LAST NAME, FIRST, MIDDLE / BUSINESS 3 A/J 4 R/S 5 DOB/AGE P.R. VICTIM OF VIC DV 'a , WITN. L_l (� L /- . .r �`(T) J V L 1.-- - ! Lam' ✓ ! G- 1 { 1 V+') � 1 ` '' 1 DOMESTIC VIOLENCE? U r PAMPHLET Mi GIVEN ' (�'. PAMPHLET GIVEN • A C....-.),1 a../' / len , /t ^- l a'. 6 SS# 11 6 VICTIM OF 1 2 3 STATUTE (-) 10 BUSINESS ADDRESS • fs,1 f' 1 ) 1..' VICT. n P.R. Ci W TTN. 0 6 SS# i RESIDENCE ADDRESS 8 RESIDENCE I) N/A STATUS �02,FULL YEAR SC �OQOL CITY ✓tUL=P�� 2 LAST NAME, FIRST, MIDDLE / BUSINESS 11 6 VICTIM OF STATUTE -I 1 1 2 3 0 0 '`J 0 BUSINESS ADDRESS EXTENT:OFINJURY. \/ICTIM #1 VICTIM #2 VICTIM #3 /?INJURY TYPE. VICTIM #1 VICTIM #2 VICTIM #3 SCHOOL NONE 0 0 N/A MINOR 0 0 0 ZIP 7 RESIDENCE ADDRESS 8 RESIDENCE STATUS / CITY / ZIP SERIOUS (2) 0 GUNSHOT FATAL 11) n STABBED /APT. # /CITY a PART YEAR (6_3) NON-RESIDENT 11 DAY/TIME AVAIL. r✓-S 2 N/A ` FULL YEAR / STATE 9A RESIDENCE (0 N/A TYPE 0 CITY 12 OC PATION/TITLE., v Z-4 VICTIM OF VIC DOMESTIC ka) PAMPHLET CO VIOLENCE? (E, GIVEN �I ) /APT. 13 RES. PHONE ( ) DV PAMPHLET 0 GIVEN a /CITY /STATE 02, PART YEAR (631 NON-RESIDENT 11 DAY/TIME AVAIL. 2 LOCATION ON BODY VI. #1 VI. #2 VI. #3 LACERATION g3; �1 UN CONCIOUS L! (541 /ZIP v02' COUNTY FLORIDA 3 A/J OA J /COUNTRY OUT OF STATE 14 BUSPHONE /7 4 R/5 5 "DOB/AGE ( /ZIP /COUNTRY 9A RESIDENCE ;a N/A (..0) COUNTY TYPE 01 CITY CD :: FLORIDA 12 OCCUPATIOWTITLE 13 RES. PHONE ( ) 3 HOSPITAL/CLINIC VI. #1 VI, #2 VI. #3 PUSS PUSS. II T EHNAL Lu5] Ul' BROKEN 8ONES INJURY TEETH (G51 a' CL-i i a 6L6) @J L, OUT OF STATE . 14 BUS. PHONE ( ) BURNS L' ABHASIUNS/ BRUISES u SOUAD 4 OTHER E9: a ':/k:: 1 ' PERSON INTERVIEWED 2 A/J 3 AGE 4 RES. ADDRESS CITY APT. # 5 BUS. ADDRESS RES. PHONE BUS. PHONE ( ).. E. S, t' 2 s;'F1=: Y: PERSON INTERVIEWED r".;:,, . 2 A/J 3 AGE 4 RES. ADDRESS CITY APT. 45 BUS. ADDRESS �- RES. PHONE BUS. PHONE• (.::.)::-:.";,1';')..: C 0 u 0) C 0 C TS 0 0 0) 0 r-I 00 N '11 0 C 0 E 0) c 0 CL 1— Q c0 0 EMS Q (_) momu r• 1 LAST NAME, FIRST, MIDDLE 1 RESIDENCE ADDRESS / APT. S /CrTY / ZIP CI' ...• 3 RES. PHONE ( ) 4 BUS. PHONE ( ) tr i 5 MEM: E 1 MEM,+1 c " 5 BUSINESS ADDRESS l CTTY / ZIP CODE 6 USUAL OCCUPATION 7 INJURED • `) YES 0NO C, FATAL 8 CTTI7FNSHIP (1 P E .;. NO s 9 NICKNAME 10 NJ Q) 11 DOB/AGE 12 RACE/SEX 13 HGT. 14 WGT. 15 EVE COLOR 16 HAIR COLOR r ;F': INFO o o 01 17 CLOTHING, JEWELRY, MANNERISMS, CHARACTERISTICS 18 SCARS, MARKS,TATTOOS, DEFORMITIES: DESCRIBE 4 LOCATION OF BODY „�� r--. ,_, 1 LAST NAME, FIRST, MIDDLE 2 RESIDENCE ADDRESS / APT. S /CTTY / ZIP CODE 3 RES. PHONE 4 BUS. PHONE E s Now WE:. T G 5 BUSINESS ADDRESS / CITY ZIP CODE 6 USUAL OCCUPATION 7, INJURED QYES _: NO f---: FATAL 8 CITIZENSHIP w (--, ,, ' NO 9 NICKNAME 10 NJ 11 DOB/AGE 12 RACE/SEX 13 HGT. 14 WGT. 15 EYE COLOR 16 HAIR COLOR NNE: ca INFO o am" v �2 17 CLOTHING, JEWELRY, MANNERISMS, CHARACTERISTICS 18 SCARS, MARKS, TATTOOS, DEFORMTIIES: DESCRIBE & LOCATION OF BODY — _" 1 HAIR LENGTH >r• Q 1 - LONG erF.QCZ)2-MEDIUM � CD C23 3 - SHORT �'0)Q4-nE.cDN3Q � r -''_0-- 2 HAIR STYLE CO l 2 J 1 - A}RRDN IURA_ Q'`2©,2-BRAIDED CD 2) 3 - BUSHY 4-DIRTY3Rr'ASYlQCP4-FUZZ 3 FACIAL HAIR .,CO Q 1 - CLEANSHAVEN ')+'�'0)2-FULL BEARD Q) O, 3 - FU MANCHU 4 COMPLEXION Q Q 1 - LIGHT 1�a2-MEDIUM 2 , 3 - DARK Ql_ �i?;?j4-RUDDY 5 TEETH Q (-2';1 - BROKEN Qf2:2- BUCK TEETH' �' , ,-2-.) 3 - DECAYED CD 4-DIRTY )1� 6 APP/DEMEANOR T. (2'' 1 - DIRTY 11):2)2-FLASHY T (2 : 3 - NEAT (ii:1)4-ANGRY 7 SPEECH Q r 2.' 1 - ACCENT ;T;;z,`2-RAPID �1 :0) 3 - SLOW '(2)4-LOUD (T::2)SOFT 8 RR_ HANDED T . 2 i 1- RIGHT '._1-; 2?2-LEFT :1 1. •: 3 - UNKNOWN Q g_2/ 5 - BAILING — :--+w"s<'.(_C 6 - BALD 7-97 -1 ( \I Co A >Z g.I _, ti' i ID CO , 2) 5 - DRFAnLOCKS C f) `16 - Pr10C,ESSED Q cf.) 7 - STYLED QLFja-UNCOMBED m.a.)9-WAVYAURLY ,, 'J 0 - OTHER Q -C 2i 5 - GOATEE Q G 6 - LOWER UP Q Q 7 - MUSTACHE a) 8-SIDEBURNS Q©9-UNSHAVEN Q 2Q 0 - OTHER Li Q 5 -TANN=D Q 0) 6 - MULATTO ) U 7 - ALBINO QMe- ACNE [f)Q9-FRECKLED LT) 0) 0 OTHER • 2 5 - GOLD Q 0J 6 - GOLD LINED Q Q 7 ;GOLD DESIGN QQ8-MISSING Q0)9-VERY WHITE Q CIO - OTHER a�i 0) 5 - CALM CO- J 6 - COCKY Q �; 2 ` 7 - DRUNK COrr)8-NERVOUS if)©9-VIO.ENT 0) 0, 0 - OTHER 5 - Q' 'Q 6 - LISPS Q Q) 7 - NASAL T.'-2%8-RASPY c.;i�9-STUIiER (1i 4Q 0 OTHER 9 BUILD 0aj1-LIGHT N 3 ((DD SSING PERSON,CODE ! : <,� - ISSING 3 C _� i .J M 3 3 i, () 2 - RECOVER OOT MISSING O 3D 0 D 1 O 3 - MISSING AND RECOVERED �( N ,n.N S! •2... TYPE 9IISSENG. :/: - :;':. Q Q 1 - RUNAWAY 1 ENDANGERED Q (JD Q O 2 - PARENTAL Q G' 2 - DISASTER VICTIM Q !2 i 3 -INVOLUNTARY Qom? 3 - VOLUNTARY ADULT Q 4- DISABLED Q Q 4- UNKNOWN 3 RECOVE KY•INFORMATION. .. • CD' Q O- N/A Q IX -RETURNED TO Q Q 1 - VOLUNTARY Q G PARENT/GUARDIAN 'Q G 2 -LOCATED--NOT Q� C 7 - DECEASED RETURNED 7 ,,�' 9 - OTHER 003 O (D )ULPLAY:SUSPECTED ::..;".:::-_5.'.: I"� 3 13 I7u'1-YES O - E D Q 2-NO 3- n I 3' PERSON MtSSING PFtEl7OUSLY?'.:•:.:,_:...:.::: .. .. ...' .. .. 1Q(2,•1-YES Q �'2-NO Q Cl.) 3 - UNKNOWN : �`.• 2Q 3 -HOSPITALIZED QQS- HRSCUSTODY Q Q 5-LAW ENFORCEMENT CUSTODY ®----:�-:,Vct1;CLE.r SQSTOLEN CfiaEIZED Cif) FAILED TO RETURN ®y =`;'COMES;=" i 3^, ABANDONED Q REC'VD FOR OTHER AGENCY Q MPD STOLEN AND/OR RECVD ." '- ` CO IMPOUNDED 0) RETURNED TO OWNER L OTHER (ARSON/DAMAGE) g USED IN CRIME Q VICTIM/LARC OR Ai f-ATT 22 (IF DAMAGED, USE "0"). �2�:VEHICLENESSELT'RE�:_.,.;,,:�:.::::::.._:'.......:':•_ .:, .. .. ... GPAUTO u CAMPERJRV , Q BOAT CrTRUCKNAN C BUS . gJ AIRCRAFT .a3' MOTORCYCLE 0) TRAILER ., (15' OTHER am.-,'--•, 3 YIN # / HULL 4 IN 4 DECAL # 5 HOW WAS VINULL ACOUIRED? M 6 MAKE ®yam t�f) `;`'i 7 MODEL s'� 8 YR. 9 BODY STYLE 10 LJC. #/TAG #NESSEL REG. 1,L g is qS 11 YR. 1G� 12 STATE /',� as - _ 13 VEHICLE COLOR / COLOR RANGE ' 14 SPECIAL VEHICLE FEATURES / CODE FEATURE TOTAL 8 OF VEHICLES 4 TOP BOTTOM TOP BOTTOM s fir, Q Q BLACK 10) O RED/MAROON Q LEVEL ALTERED �` DAMAGE TO REAR © Q DARK BLUE 1Q 0) PINK ® _ Q3 Q LT. BLUE/AQUA/TUROUOISE CL-2.) (13, BEIGE/TAN ®_.5. Q Q DARK BROWN 13) L•)J WHITE Q QS LT. BROWNBRONZEJCOPPER :-4) ) YELLOW ' _ © © PURPLE 1 , 1, ORANGE/GOLD .: Q Q DARK GREEN ( ) 4( ) OTHER/UNKOWN ® QO LT. GREEN/LIME/OLIVE ILL OS GRAY/SILVER Q STICKER/DECAL ON BODY/BUMPER 1) DAMAGE TO SIDE C STICKER/DECAL ON WINDOW a BODY PARTS) DIFFERENT COLORS 14� RUST OR PRIMER SPOTS 0) VINYL TOP 0) PAINTED INSCRIPTION ON BODY T EXTRA ANTENNA(S) OR INIRROR lam' DECORATIVE PAINT O SPECIAL RIMS/T)RES CZ) MISSING PARTS ) LOUD MUFFLER T WINDOW BROKEN 9) OTHER/DESCRIBE-BELOW ® DAMAGE TO FRONT ' Q 0..,(� Q Q (.CQ �..® Q:( Q.Q i Q _ Q u ". 15 ADDITIONAL DESCRIPTION 16 TAG COMES BACK TO: NAME, ADDRESS, STATE, ETC. 17 DOORS LOCKED? s,'a QYES QNO 18 WINDOWS CLOSED? OYES QNO 19 KEY 1N IGNITION? QYES 0NO 20 FINANCED BY 21 DATE OF LAST PAYMENT 22 INSURANCE COMPANY E= 23 PERSON LAST DRIVING.VEH-, I24 R/S r, IJ 25jDOB/AGE - 26 RESIDENCE ADDRESS (ZIP) PHONE 27 BUSINESS ADDRESS (ZIP) PHONE fl28 LOCATION OF RECOVERY OF M.V. '129 RECOVERY MILEAGE 30 STRIPPED? '31'DISP• a •N OF VEHICLE C QYES QNO 1 TOWED Q OWNER ,, 32'C_ONDI17ONy aYGOOD Q POOR '.' ,.: Q FAIR ©STRIPPED 33 VEHICLE TOWED BY/WHEERE? 34 IF 007 RECOVERY - MSG.* AUTHORITY $ i1DiREQUSTED,T,;r Q' YES 10 NO 2 SCENE PROCESSED? 0 YES' 0 NO 13 WAS PHYSICAL EVIDENCE OBTAINED FROM THE SCENE? 0 YES Q NO 1'E 4 LATENTS Q YES ® NO 6 EVIDENCETO Q YES 7 ID TECHNICIAN J PIN # / UNIT # 8 FIRST OFFICER ON SCENE PIN # UNITS , I73 5 PHOTOS 0 YES c NO PROPERTY UNIT 0 YES 1 Y' J�-, DRUGACTIVITY} ,� :.y .k`� -..:,, .k.-fi. - _-k i DRUG TYPEr.. z �..w ='-- � .® SELL D�- TQ WA ®DISPENSFJUISTAIBLTTE R CO BUY ® MANUFACTURE/PROD UCEICULTIVATE Q TRAFFIC S-G ® DELIVER 0) POSSESS UNKNOWN 4- 0 USE 0) SMUGGLE QT OTHER ., .. (I. N/A 0) HEROIN ()) PARAPHERNALIA EOUIPMEI T._i AMPHETAMINE a HALLUCINOGEN 0) SYNTHETIC BARBITURATE-' 0) MARIJUANA (II) UNKNOWN �^� � © COCAINE 0) OPIUM/DERIVATIVE ,A) OTHER A-tCTJ J'(l •' ' sal mama IN 111 ES -9 ='-CRIMES:'AGAINST PROPERTY01.0 ENTRY FRONT REAR SIDE (I) DOOR WINDOW SLIDING DOOR (T) DUCT/VENT ADJ. BUILDING ROOF 71 WALL 3, GARAGE DOOR 1) OTHER/UNKNOWN EXTT 19' 2 PROPERTY TARG.. . Q BUSINESS MACHINES C• BEER/LIOUOR (-3-) CIGARETTES CKS/CHECK MACHINES (LSI' CLOTHING OJ ELECTRONICS 27) FIREARMS �) FOOD (9; JEWELRY cis; TOOLS a,: OTHERS 3 METHOD OF BREAKING Cti BREAK/CUT GLASS (; BREAK/REMOVE DOOR PANEL r33-) CUT/BREAK LOCK r4-, CHOP/SMASH a) CUT/BREAK SCREEN a; HID IN BUILDING �7) KICK/PUSH .PICK LOCK '19) PRY/JIMMY 113 REMOVE JALOUSIE REMOVE AIR COND./FAN (rz REMOVE WINDOW/DOOR 'IV -SMASH GLASS —TAKE MERCHANDISE (?4) UNLOCKED/NO FORCE a; OTHER 4 INSTR....._NT USED BOLT CUTTER BRICK/ROCK CHANNEL LOCKS' VISE GRIPS A j CHOPPING TOOL a.. CUTTING TOOL CUTTING TORCH 7; FEET 13) HAMMER `9) KEY 30' PRYING TOOL a; SAW/DRILL SCREWDRIVER 'fa' TAPE !1c, VEHICLE 0.9. OTHER 5 PREMISES SECURED DATE: TIME: 6 TYPE OF PROTECTION LOCKS 2; BARS SILENT ALARM '!) AUDIBLE ALARM 5: LISTENING DEVICE :b; MOTION DETECTOR OTHER 7 BURGLARY ELEMENTS Q ALARM INOPERATIVE C% BURGLURIZED DURING LAST 12 MONTHS ® ADMITTED STRANGER OP. TRADESMAN DURING PAST 7 DAYS (RES. BURGLARY). I3) TELEPHONE SURVEY, UNUSUAL CALLS, WRONG NUMBER, HANG-UPS DURING PAST 7 DAYS Cr., TENTED, UNDER CONSTRUCTION ® SAFE OPENED/ATTEMPTED C 1 OTHER 7 BURGLARY ELEMENTS O: ATE/DRANK ON PREMISES (2; BROKE INTO COIN OPERATED MACHINE ' (3-) BURGLARY NOT COMPLETED ( ) DEFEATED/ATTEMPTED TO DEFEAT ALARM S DEFECATED :J DISTRACTED VICTIM IMPERSONATION B KNEW LOCATION OF HIDDEN CASH ® LEFT TOOLS ON SCENE (Lb, MALICIOUS DESTRUCTION J NEATLY SEARCHED 1 PIGEON DROP `3, RANSACKED ENTIRELY rid) RANSACKED PORTION Lis' REMOVE PRINTS/WORE GLOVES (TS,': TRICKERY �J TRIPPED ALARM AND RETURNED LATER (L8; TURNED LIGHTS OFF —ON a USED TOOLS FOUND AT THE SCENE I . OTHER 9 CRIME SCENE INFO. ID REOUESTED? 1-7 YES IF NO EXPLAIN WHY ) SCENE WET r-: ALREADY CLEANED BY VICTIM r3 i SURFACE NOT CONDUCTIVE TO PRINTS CD CONTAMINATION EXPLAIN IN NARR. 10 VICTIM WAS J HOME a) WORK C; VACATION ,-, GONE • ._ �..._-- � � _ - . _ _ '�: -� _ �=: . _. T �CRIIUIES=-�►iaA7NSL��fi5DNs��. �; __ ., _ ++p _cam �e>=a:S"'.�✓� �-.}�-u-�..�,�:-�--�-"r�- _ _ _ � .,c.�;�=^'>-a' � '=- .r=•<u..F� --�3r'''-' ��. 4t�"-,�.= 1 TELEPHONE O CALLED VICTIM (BEFORE/AFTER) C PULLED OUT CORD TJL- OO SUSPECT USED VICTIM'S PHONE USED CORD TO TIE VICTIM 2 SUSPECT'S ACTION (ROBBERY ONLY) ASSAULTED VICTIM 10' SEX ACT INVOLVED 2 ASK FOR OR BUYS MERCHANDISE 11 SHOTS FIRED ✓ APOLOGETIC rill. USED LOCKOUT ® DEMANDED JEWELRY 13) USED MASK ®, MADE THREATS USED NOTE © OTHER 3 VICTIM IS (WAS) O ABOUT TO ENTER HOME t✓ INTOXICATED I✓ ALONE : e' OPENING/CLOSING BUSINESS rsm ELDERLY C) RETARDED Cdp GAMBLING a OTHER . ® GOING TO BANK G OTHER THEFT INVOLVED .1S)USED STOLEN CAR Cr.) PRODTITUTION INVOLVED �,9a OTHER ® HANDICAPPED C PURSE SNATCH PUT MONEY IN BAG 4 FORCED VICTIMS TO (JJ DISROBE $ ENTER CAR TRUNK `. O' ENTER RESTROOM ` :. ® GET MONEY FROM BANK, FAMILY, ETC. ;�: COGO TO ANOTHER LOCATION Q LIE DOWN 1Q OPEN SAFE. * 5 FORCE USED ON VICTIMS O ABDUCTS O CUT/STABBED VICTIM 2 BLINDFOLD VICTIMDELIVERY O GAG VICTIM Q BOUND VICTIM ® HIT VICTIM 4Q BIT VICTIM a SHOT VICTIM ®COVERED VICTIM'S FACE LiTj THREATS ONLY CHOKED VICTIM a OTHER 6 IMPERSONATED a, O CUSTOMER RENTER PERSON'COREPAIRMAN Q2 O L,, DISABLED MDTORIST ) SALESMAN ® DRUNK 13 SEEKING AID ®_iv1PLOYEEIEMPLOYER QI) SOLICITING FRIEND !T5' SURVEYING CD INJURED a OTHER. ) PUT PROPERTY IN SACK OF BUILDING POLICE/LAW O REAR ® RELATIVE -P` 7 SOLICITED, OFFERED r' Q AID FOR CAR OD GIFT/PRIZE . . tr O ASSISTANCE/INFORMATION Q8 MONEY 'J3 CIGARETTE ® PROSTITUTION/SEX ® CON GAME J RIDE ® DRUGS USE OF PHONE ® FOOD, DRINKS, CANDY CJ OTHER 8 CHARACTERISTIC OF SUSPECT (SEX CRIMES ONLY) 0 ANAL SEX eQ ORAL SEX 1a UNUSUAL ODOR (BODY ODOR; Q APOLOGETIC Lim MASTERBATED SMELLED GOOD, ETC.) 0 CHILD MOLEST 1LB; RAPED MORE THAN ONCE El) USED LUBRICANT ® EJACULATED 1TT1 RIPPED/CUT CLOTHES (I) USED VICTIM'S NAME ® FOUL LANGUAGE 1rLI UNABLE TO ACHIEVE ri`61 VIOLENT © GENTLE ERECTION OTHER 3 . G7/ MAKES THREATS %F STATUS TYPE`°7;'; 1Q FORGED 31 COUNTERFEIT Z) FORGED AND UTTERED II COUNTERFEITED AND UTTERED lAt ... , ,.. ® CHECK (3) MONEY ORDER `S,'+ ATM/DEBIT CARD Cr,," PRESCRIPTION C) OTHER TYPE• 'O`"""' -' 02 CREDIT CARD 4 BOND/CERTIFICATE CE) IDENTIFICATION t Bi TRAVELERS CHECKS IV CHECK T.• CRIME SCENE SPECIFICS 1 CHECK NO. 2 AMOUNT 1.CAN OFFENDER BE IDENTIFIED? Q YES 0 NO 2.OWNER OF CHECK NOTIFIED? 0 YES 0 NO 3 CHECK PAYABLE TO 4 DATE OF DOCUMENT IF YES, NAME .:. 3.THEFT VERIFIED? 0 YES Q NO ,V t,, 5 BANK DRAWN ON 6 SIGNATURE ON FACE (MAKER) IF YES, CASE NUMBER P.D. -0 . .. 4. WAS OFFENDER ENDORSEMENT OBSERVED? Q YES CD a' C O.-1 7 ACCOUNT NUMBER )i--. 8 OWNER OF CHECK (PERSON OR COMPANY) 5. WAS OFFENDER(S) PHOTOGRAPHED? 0 YES Q NO y O pD 6.FORGERY AFFIDAVIT OBTAINED? Q YES 0 NO U fV 11t TYPE OF IDENTIFICATION USED 7.HAVE THE ORIGINAL DOCUMENTS BEEN PROTECTED FOR EVIDENTS? °. O III `"I I S. ' 9 DRIVERS LICENSES • 10 STATE 0 YES Q NO WHERE? C .. C CREDIT CARDS C £_ 11 OTHER LD. (DESCRIBE, INCLUDE S's, PHOTO I.D. ETC.) i.. ,..... 12 COMPANY NAME 13 CARD NUMBER .. 14 ISSUED TO = - = I c Al .,,f ft _ 4-. .� n P1 0 u 1 E INN m NOB NMI INN m r MEI Im OMNI MEM MEM r® m• • MCI I® MANI O VID I® MOS !i m• EMS NM▪ I ORM ISMS EERY EMI I® ISMS NINE OMNI NEE MEI Ega In▪ n EWE 417 V v ( bkkg11.#01.4#21iPm.!;LTAMPZI 4,5.,:YAte*: Vg-K-04":44',VgliDFFICEFIASSAULTEDIKILLED "TI,Vs.,'!it'io'kit,:wii.V.-::,•;•*:Ki,.,z-v: PIN • ' t.Xi.;':kl . ._ fr 1 '4NQ. ... PW" :,.........OFR�R,...AC11VTTY. .• .. . . (71Q:;c0;91:1 ar_51:D• Gp co c) :,: Now ci:),44:(1) (D,(1?a) CD.Ck.. a-) .q)2(1).11 ):,1cD .a.i� 3".) • CID CD (3) (re) • a) Mal (21).. (T). GO , CD!' (17_,....,..GE;,,,co ..: (is) go ID :W:65....d).d),*(1): ap.a).. (ED Nor .:).1.25;(/D.:(t)...0:.a). ct.:_5.:': (D--) .. - a-.) OFFICER KILLED FELONIOUS ,a, OFFICER KILLED ACCIDENT OR NEGLIGENCE a:', OFFICER ASSAULTED, NO INJURY a) OFFICER ASSAULTED, MINOR INJURY a) OFFICER ASSAULTED, SERIOUS INJURY . W RESPONDING TO DISTURBANCE M DOMESTIC DISTURBANCE (I) BREAKING AND ENTERING IN PROGRESS 2, HANDLING, TRANSPORTING. • OR PURSUING B. AND E. SUSPECT CUSTODY OF PRISONERS ("I) ROBBERY IN PROGRESS OR PURSUING -iS) INVESTIGATING SUSPICIOUS ROBBERY SUSPECT PERSONS OR CIRCUMSTANCES a; ATTEMPTING OTHER ARREST '....PD AMBUSH. NO WARNING Cr.. CIVIL DISORDER a! ASSAILANT MENTALLY DERANGED 0:1) TRAFFIC PURSUIT OR STOP ri'2, OTHER mom . Ctl- 'cc, ai:J3.•.(245 a)-;;. o • 11 -1 2. A.. ,,, .Y M CD c 3 o '3" : -s 3 ! 0 a — . ;. 3 FDP &z. a) CD • CD m:?-.. at) • .... m..). • ) c.-.ii, CP) 3 TYPE OF ASSIGNMENT. .;. - '. • •' •• .... '' .-.- ' . :. • ' CD ONE PERSON, VEHICLE, ALONE a, DETECTIVE OR SPECIAL CE, ONE PERSON. ASSIGNMENT, ASSISTED VEHICLE, ASSISTED (C, TRAFFIC/MOTORCYCLE c3, TWO PERSON, VEHICLE OFFICER a) DETECTIVE OR SPECIAL (72, OTHER,ALONE ASSIGNMENT, ALONE 'Cflp OTHER. ASSISTED 4 (ANSWER . ALL QUESTIONS Y N UNK N/A WAS OFFICER WEARING BODY ARMOR? ,---• ---• t-• DID ARMOR PREVENT SERIOUS INJURY OR FATALMY? (.:_m ,:,-.; c.-.- C) WAS OFFICER AWARE OFFENDER HAD WEAPON? C__-, () DID OFFENDER USE OFFICER'S WEAPON? C_-, CD r-:' C) WAS A FIREARM DISCHARGED BY OFFENDER? C; C; C) (--- , - a: 5 ' WAS OFFENDER IN;JURED?..-. 0 YES (---) NO (--.-• UNK. D/STANCE FROM OFFICER IN FEET (ESTIMATE) 37 D 0 2 5 -''';ci.'..-• 0 ., . ;13) CD EXTENT Of INJURES TO OFFENDER ,) N/A • -ea MODERATE la FATAL 0) MINOR 10) SERIOUS WAS A FIREARM DISCHARGED BY THE OFFICER? OE1' , C_—_, 3" D l'sJ ,-P 7" • .: •.:..c.)f0*:41*giP-.!•.:.04. Y'14Sj ..*:i'•',.: E 3 3 CO a• o . I-' 1:1 ° c :; 7':itiFF" iCER'' -'ASS - AULTEDIYOfFE NDERPS- OSPECTi A Cr 3 A: 3 7" Ft .1.: '11 -) ,''i:- CD PROP.S - STOLEN R - RECV'D FOR H - RETURNED TO OWNER E - EVIDENCE/SEIZED CODE F - FOUND OTHER AGENCY K - PHOTOS TAKEN PROPERTY Y - MPD STOLEN & REC. D - DAMAGE (INC. VALUE) P - PERSONAL RETURNED TO OWNER A - ARSON (INC. VALUE) 1 PROPERTY RECEIPT 4 2 3 4 PROP. VIC V QUAN. CODE . 8 DESCRIPTION OF ARTICLE SERIAL P, MODEL, BRAND NAME, ETC. 6 VALUE 2 PROP CODE 3 VIC 4 4 (DOAN. 5 DESCRIPTION OF ARTICLE SERIAL P, MODEL, BRAND NAME, ETC. 6 VALUE . I fl.:LAPAIgfE43EDA;g:-;!,::;":?f#il4..:47,•':,!..;:,. •:;1..;:;:' :;':::::,:,::::::7f,";::i:)T: ill• (7) 00 - N/A (:) a) 06 - BLUNT OBJECT WI ) (7j) 12 - SIMULATED .mun W W 01 - HANDGUN CD W 07 - HANDS/FISTS/FEET WI C) 13 - DRUGS a) a) 02 - RIFLE W IM 03 - POISON • . CD (rt BB - UNKNOWN W � 03 - SHOTGUN 09 - EXPLOSIVES (T (I) 99 - OTHER -.. a) 04 - FIREARM 00 10 - FIRE/INCENDIARY (NARR.) :- 2 WEAPON FEATURES W a) 01 - cHRomENcKEL rim 07 - DOUBLE BARREL C), C_2) 13 - LG. BORE W a) 02.- BLUE STEEL cp. ___.1 03 - SINGLE BARREL WI ) M 14 - SM. BORE (I) a) 03 - AUTOMATIC ) C.: ,I) 09 - SAWED OFF 11) CZ) 15 - OTHER CD CI.) 04 - REVOLVER 0 OD 10 - PUMP DESCRIBE T) M 05 - SHORT BARREL 0-_;) (1 11 - BOLT ACTION CD 12 ALTERED STOCK © 05 - KNIFE/ C), IM 11 • THREAT/INTIMIDATION CUTTING INST. CD a), 06 - LONG BARREL - ..-,,F. 3 CALIBER/GAUGE Z:= 4 MAKE 5 SERIAL ir. 6 BARREL LENGTH 7 MODELI 8 COLOR 9 TYPE OF GRIPS 10 BUTT MPNARR . - /i79-19:.• • . '.-e - L/ . tirVVe12," .Z- ? XN1 L' 12-5 t'r f-9F i 14-01 / "3 AirA. --3 .1./Ng41 / - -v. I/ 41 4-1 Z r C - P - - P - - - 5 ---- in. )63-z---e.:),3-.4P7 9-n4/1-5 5-.-7-01/ Tho-ii-,/ eye--#,J f--7_9 0 , ,,,,,,,Tat- _._,4&,,..--:..„. . . . . ..---..:. / ---,,F, )... .-- ,.: t. ..... , 07-1-17-e-7.7 ;:-.3---7.Zt7 1.,:.',.:...:LinAiR f----.--,..-e-i.H ' T co-4 •/.-- 1 -)- ' 0 , -7-bp:07,-0 ftz'c.,/ . . . . . . . • - .. • . . :. .. 717-7n, 0•..' -241,:,6 .::L5.• -6 y tov.--g.' ]• .--*;3 -7D, ,- . .;,(4, _7-i.'-ro-1 e- 5-(--S-V-i-,) 2-6-47D 7, , . .-,. _ . .,./ ..} ' '1. '.?%,-;•:5-87t7)...'.•6--. )'-r7WC:-"'"''::'-77H-g-''tlt'V. - .8*--... .. . /7-\/ -77-i--e-,•, . .., _..,.., .. A- (vrom. .-.-D" . g.-17'n'I',-.Pa-12S . CO-FW IPI 1._,--%**CZ, C-A-R-V . 7Thr Aqt-'0 - ---' • . . • - , .• ,.; , --.- .--:.,-. ..44,••:- ,• .,..143.5a-OT-Lv 57,-•fe9 ) ,7-1 g CQ r . .. 3---7V cRig.(-)717-S , - ,..,,, 4 - , - , -. , _ ....,,,.• . PV-1-1-A8-2-P-- ------: -i-C--- • I?. V " 0 1,--,,,-17 -1-4-711 TPrr11,2:K 57-6-71fre>j-r)-7-) 75.)\ I I3 -J 6-2 4 Mal 1-07--1-1 A gS.19c))-‘,--6- t,-r. .071 . Wisve-9- Mark Reflex. by'NoS EM-154334-2:1312111098 GS03 .,43.1,trzmg...?e,v-mt,"p:EfsoNozroxFuglti„:1t9,§y.o:T.,A...:VM:',ii4;ac MIAMI POLICE DEPARTMENT "INTOXILYZER 400" BREATH TEST CHECKLIST Subject's name Last: First Middle initial Test date: Test Time: IP-%-o D3v3-03tf Time of first observation: Instrument Serial Number O76 FcV OPERATING INSTRUCTIONS (check off each procedure as completed) Test Number: / 1. Switch Device on 2. Follow Instructions on Screen 3. Attach Mouthpiece ,' 4. Instruct Subject to Blow 5. Take Sample 6. Record Reading 0. 7 s' G210L . u'scar a Mouttlpiece 8. Switch Device Off 9. Wait Two Minutes 10. Switch Device On, Follow instructions on Screen 11. Attach Mouthpiece 12. Instruct Subject to Blow 13. Take Sample 14. Record Reading 0. 0 9' / G210L 15. Discard Mouthpiece 16. Switch Device Off Operator's Name/Printed Signature ID Number V, -r 0 &-c 2/ "INTOXILYZER 400" BREATH TEST CHECKLIST Submitted into the public record in connection with item DI.1 on 01-28-10 Priscilla A. Thompson City Clerk STATE OF.' .FLORIDA DEPARTMENT OF HIGHWAY SAFETY AND .MOTOR VEHICLES DIVISION OF DRIVER LICENSES NOTICE OF SUSPENSION covxrr M1 n inn 9-P--r‘ F.H.I0P.D. D S.O. 0 OTHER :rr14217 AcipwC. 11 " iI/���/rY��-� ��,�Yr_7147 Q P./A A.M.. NAME itY o " tr" cs pE-6,vk- m CHECK Mill vh� v 1 s) NAME.OFPARETT Le; l ICEM,E NO. 7'13 irP YR�G IJCP. TIIEPE3ONE'Ntn6BER . EFFECTIVE THIS DATE YOUR DRIVING PRIVILEGE IS SUSPENDED FOR: BEING. UNDER THE AGE OF 21 AND DRIVING OR IN ACTUAL ;;PHYSICAL.CONTROL OF A MOTOR VEHICLE WI4TT ,F. HAVING A BREATH ALCOHOL LEVEL OF 0:02.OR HIGHER. THIS SUSPENSION IS FOR A PERIOD OF 6 MONTHS FOR A FIRST .'.:: VIOLATION, OR FOR A'PERIOD OF 1 Y.EAR IF PREVIOUSLY SUSPENDED FOR DRIVINGOR BEING IN PHYSICAL.CONTROL OF AMOTOR VEHICLE WITH A'BREATH ALCOHOL LEVEL OF 0.02 OR HIGHER BREATH ALCOHOL LEVEL:. REFUSAL TO SUBMIT TO A'BREATH TEST UNDER F. S. 322.2616. • :.THIS SUSPENSION IS FOR A PERIOD OF ONE .YEAR IF THIS IS THE FIRST REFUSAL OR 18 MONTHS IF' PREVIOUSLY SUSPENDED -FOR :REFUSAL TO SUBMIT TO A:BREATH, 'BLOOD OR URLN'E: TEST.: :NOTICE WAS HAND DELIVERED TO DRIVER ON /*7� DATE IYcenseSurrendered4 Yes O,.No, Eligible for. permit? 63 Yes .:0. NO Unless' ineligible, this suspension notice shall serve as a. temporary driver's lir-ncv and •;expire'at midnight on the loth day following•the date of. the issuance of `this notice: This permit becomes effective after 12 hours have .elapsed from the time of. issuance of this notice. •Af the 'fir,) )• • DHSMV hearing office, you may request, • within 10 calendar days after the issuance of this suspension notice, a review of the suspension by th.Dcpartrnent ofHighwa Safety and .Motor Ve ' les. (See reverse side.) .., NA OF DRIVER F'OFFICER.BADGE# IDR TROOP/UNIT, . WHITE-DHSMV HEARING OFFICER PINK -OFFICER -AGENCY COPY HSMV 78103 (REVIf9/05) YELLOW -DRIVER'S COPY Submitted into the public record in connection with item DI.1 on 01-28-10 Priscilla A. Thompson City Clerk 111;EATH TEST RESULT AFFIDAVT. JR UNDER AGE 21 SUSPENSIONS STATE OF FLORIDA COUNTY OF rJ ) ) 1 9A.V 1 Y reby swear or affirm that I - administered a breath test to 3—eS "S N).S1-5,-r l , Driver License No. I (%? 7 0.c (i yplc4 , accordance with s. 322.2616 F. S. The first breath sample was ; collected on )Q= 7-Q at , resulting in 0 (date) (time) ::•:grams of alcohol per 210 liters of breath (g/210L.). The second i eath sample was collected onii'74 Tat 0307 , resulting `(date) (time) in-d '_g/210L. Tliefireath test device used; i'/J' px iI,1�z D •!(name). yin'? . ,.is listed in the U: S. Department of (Serial No") rarisportation's conforming products list and has been calibrated heiked III accordance with the rnantrd3cturer''s and/or agency's 'f4FFLYSE4) .fg egoing ins Ore •e,on this making statement THIS AFFIDAVIT- MUST BE •NO OR ATTESTED TO: • . _ [F S. 117.le] was jo�lydged, .,Tice.fo;ego f instrument was swom to and Critic fore fore me. • sspeosonally known to me of who 'i:proidnccd a s-idcrifi5cation. SIGNA7UREOF NOTARY PUBLIC TITLE fDL/I DATE �V V STING OFFICER • "NOTE: Mtil•or hand deliver to the designated Bureau of Administrative Reviews office, .;Depariinent of Highway Safety .& Motor Vehicles,::"with the notice of suspension. A. JAVIT OF PROBABLE CAUSE STATE OF FLORIDA COUNTY OF ,4 /y `i ) I, 171TV.)9 — L hereby swear or affirm that 1 have probable cause to believe that ,T /Yz3 S > T was on 1Q" ;"'Gunder the age of 21 as determined by the following: t1riyer License ❑ I.D. Card ❑ Other: , and was driving or in' actual physical control of a motor vehicle in this state with any blood alcohol or breath alcohol level or while under the influence of alcoholic beverages, to wit: 1 t i V rP uffts- . 19- e37-) e0-Kf"6 52.Z" 757- ,r..(?') y icy r'r, t`1. r)=IC gt( VA-5ST 1' (I -� 1- Pae of $IW EN CEMENT OFFICER (AFFIX SEAL) THIS AFFIDAVIT MUST BE NOTARIZED OR ATTESTED TO IF. S. 112181 The foregoing instrument as 4wledyliTli :oreg instrum=nt Was sworn to and bef6 thisday'of ' scribed fore me. • 20 y .. . _r D�Jj cj� Who is personally known to me or Who produced as identification. SIGNATURE OF NOTARY PUBLIC • . rrrLE• ;7;.1 DATE • NOTE: Mail or hand.deliver to the designated Bureau of. Administrative Reviews office, Department of Highway Safety & Motor Vehicles, with the notice of ruspensibri. • Submitted into the public record in connection with item DI.1 on 01-28-10 Priscilla A. Thompson City Clerk rt) fr) C cr o ° 3 3 in — • Ey 0 CL 0 -5. co 1. fD 0 0 (1) BREATH TEST RESULT AFFWAVIT FOR UNDER AGE 21 SUSPENSIONS STATE OF FLORIDA . COUNTY OF /4 /A-11// 4.V4,70 ) 9-09v1V C./1--'it-, hereby swear or affirm that I administered a breath test to 11-1V571 71400) )0w, Driver License No. 7-5--7a5o1cl, is-0 0 0. )-7 g/210L. The breath test device used, jrN/7DX /(0 (dame) 0 *-7‘ o TS 17 , is listed in the U. S. Department of (Serial No.) Transportation's conforming products list, and has been calibrated in accordance with s. 322.2616 F. S. The first breath sample was collected on /0 --3° -Dcf, at 0 i Y.( , resulting in O. /t (date) (time) grams of alcohol per 210 liters of breath (g/210L.). The second breath sample was collected on IA-3047a O27 , resulting (date) (time) . . and checked in accordance with the manufacturer's and/or agency's pineediires. • . gnature of pth n ma king statement CAFFIX SFAL) . ;The foregoing instrument was acknowledged before rne on this day of ,50 C''r 26 0, by Who Is personally known to me or who has ••• produced SI ATURE OF 2:9?fiCiRr TITLEPo-z—-(Zia PUBLIC • DATE 0-30-09 THIS AFFIDAVIT MUST BE NOTARIZED. OR ATTESTED TO IF. S. 117.10] • The forgoing instrument was s m to and subscribed before me. N...OTE. Mail or hand eliver to the designated Bureau of Adminitrative Reviews office, ,:...tieliatrinent• of Highway Safety & Motor Vehicle,•with the notice of suspension. Ali WAVIT OF PROBABLE 'CAUSE STATE OF FLORib5A • COUNTY OF './14 /fiLf6 ) 9-10/gj) , hereby swear or affirm that I have probable cause to believe that 0/0-"V.Aig531.1142,14:1607- was oti rP-07under the age of 21 as determined by the following: vr: re.t .9,4-fig Driver License • D I.D. Card D ..Other............., and was divingcontrol of a motor vehicle in this state with any blood alcohol or breath alcohol level or while under the influence .of alcoholic •beverages, to wit: r ri:: s-7:7;p&-V• /),\I ,:•,, .• , )7A/ 1?:7-7Tevar.74-714.0.,ThQ49 v7c,L,5-frvicts A7-iv 9)v-P-- fisbogr frr t") (AFFIX SEAL) :Page____of E OF L FORCEMENT OFFICER THIS AFFIDAVIT MUST BE NOTARIZED OR ATTESTED TO [F. S. IIT.I 01 The. foregoing instrument was acknowledged The foregoing instrument w before Inc on this day of 31) oc.-r- subscribe ore me. 20 d‘r, by Who is personallyknown to Inc or who has produced as id cation. / SIGNATURE•OF NOTARY. • • om to and SIGNATUREOFFIESTING OFFICER TITLE vph cz-62 DATE f 0-30--0q NOTE: Mail or hand deliver to the designated Bureau of Administrative Reviews office, Department of Highway Safety & Motor Vehicles, svith the notice of suspension. N co AI''1411)AVIT OFPROBABLE CAUSE STATE OF FLORIDA :..: COUNTY OF'` Il/444f" :::�_ I, VT'1r el• / s hereby'swear or affuvi that I have probable cause to believe that gc,i'..% ./2., Ol7 1Gr)ez„ was on lO Z .09tiuderthe age of 21 as determined by the following: Driver License ❑ Other: 0 I.D. Card' and was driving or in actual physical control of a motor vehicle in this • state with any blood alcohol or breath alcohol level or while under the influence of alcoholic beverages, to wit: R c1,JVpi it A $iLVt5-12„ SC,1 B7,) /5 vh^ zA l -49 s 'r-/- MS 9/ 97 . x A f i.,)I S (AFFIX SEAL) The foregoing instrument was acknowle ed before me on this day of % 20p/, by Who is onail f o me or who has produced ide tifica SIGNATURE OF NOTARY PUBLIC Page of ENFORCEMENT OFFICER THIS AFFIDAVIT MUST BE NOTARIZED OR ATTESTED TO [F. Si 117.10) The foregoing instrument was swoin to and subscrib.Ad before TITLE POi i c, : B G62 DATE (V 2 V 9 NOTE: Mail or hand deliver to the designated Bureau of Administrative Reviews office, Department of Highway Safety. $ Motor Vehicles, with the notice of suspension. BREATH TEST RESULT AFFIDAVIT FOR UNDER AGE 21 SUSPENSIONS STATE OF FLORIDA COUNTY OF flip9-02 L V ) T ' VA-47 . C jai hereby swear or affirm that I :administered a breath test to k 'r-' .. Ri> KI6Q? ::Driver; License No. : 73,6" o / ` ! 51-0 in accordance with s. 322.2616 F. S. The first breath sample was collected on (O-Z7 at: =03 Eft/ , resulting in O. 13a (date) (time) rams of alcohol per 210 liters of breath (g/210L.). The second breath` sample was collected on(DOgat airs resulting (date) (time) O. f 27 g/210L. The: breath test device used, r,.r7D.X.) t- . YVT) ( ame) .97G. D , is listed in the U: S. Department of (Serial No.) Transportation's conforming products list, and has been:calibrated and cl eeked in accordance with the manufacturer's and/or agency's • procedures. nature of peon making statement (AFFIX SEAL) foregoing instrument was acknowledged '• • before me on this day of 1ip-27 .Who's pto me or who has ".produced SIGNATCRE OF OFFICER ation. THISAFFIDAVIT MUST BE NOTARIZED OR ATTESTED TO [F. S. 117.10] The foregoing instrument was sworn to and subsc befo SIGNATURE OF NOTARY PUBLIC TITLE DATE . NOTE: Mail or hand deliver to the designated Bureau of Administrative Reviews office, .:Department of Highway Safdry i-Motor Vehicles, with -the notice of suspension. • .77,,a7amlifEggif 0 Er 12 ID S. tir O ro a 3 3 3" i r1 —1 - (D O G O ry 0 10 F+ 3 93 O i � o ._.0 3 30' Pi I AFFIDAVIT OFPROBABLE'CAUSE STATE OF FLORIDA ' COUNTY OF '' 021/1- ) ` 9 ::;."�. I, 152:1V a:7 -g1' 'C --1 , hereby swear or affirm that I have probable cause to believe that 7- ci y • ') ft—f — was on t "23-Qgiander the age'of 21 as determined by the following: "Driver License 0 I.D. Card ❑'.'Other: was driving or'in"actual physical control of a 'motor vehicle in this' state with any blood alcohol or breath alcohol level or while under the influence"'of alcoholic beverages; to wit: %20'77e-K( v52 0 sw f'7A;%ervv5- /�...491472111 1 -6V S42 a).5Ci A-Nn (AFFIX SEAL) SI ATIJRE.OF:' i FORCEMENT OFFICER THIS AFFIDAVIT �BSTBE NOTARIZED OR ATTESTED TO The foregoing instrument was ackno70 edged before me on this day of 20 el, by Who is : Ito/ me or who has i4t produced S �/.n4,S as identification SIGNATURE OF NOTARY PUBLIC The fo subs S. 117.10] ent was sworn' , and me. GNAT1JRE OFA.AI IIESTIINGG OFFICER p TITLE (,9�i177U--C��/ fJ`�et'�i`LUg- DATE p61va'V NOTE: Mail or hand deliver to the designated Bureau of Administrative Reviews office, Department of Highway Safety & Motor Vehicles, with the notice of suspension _4.41,7-E0-1.13' ittF!(i:ia:�.aotin BREATH: -TEST RESULT AFrIF AVIT FOR UNDER AGE 21 SUSPENSIONS STATE. OF FLORIDA COUNTY OF . flit -I 9 69C ) I, ail) 0 CA,j2-$ sTZ'9--; hereby swear or affirm that I adininistered a breath test to ' 4, mot -fie, )river License No.. / 6017 bV 1 o / . 5:bac in accordance with s. 322.2616 F. S. The first breathsample:was collected on I grarris.of alcohol per 214:literS.of breath.; breath 'sample was collected on !D--"at )'a iesniting? (date) (time g/210L. The:: breath test device used,. ic.irOlX/trl .Z .� name) /i _ is listed in the U;.S.'Departinent of. (Serial No.) °ransp nation's conforming products list, and has been calibrated necked in accordance with the manlrfacturi is and/or agency's nature of pering statement (AFFIX SEAL) THIS AFFIDAVIT MUST BE N ::The; foregoing instrument was acchaaJgriledged -before'me on this day of VIG� 20 i7; by F : •Who is �nolo me or who has proI( duced IS A-tb t i .as identification. -SIGNATURE OF NOTARY PUBLIC The forego' subscribe TTESTED TO sworn to and A URE OF ATTESTING OFFICER P j i CAL' tc..E-P-- DATE !� z� ` NOTE: Mail' or hancIdeliver to the designated Bureau of Administrative Reviews office, Depar atent'of Highway • Safety & Motor Vehicles, with the notice of suspension. OBIS NUMBER . cOMPLAINT/ARREST AFFIDAVIT POLICE.-....E N°. -. /tD0' 3S17431 • 0 g - SPECIAL .OPERATION: ❑FELONY MISD RAFFIC ❑JLN ❑OV ❑MOVES OM INF ❑WARRANT FUGITIVE WARRANT: ❑In -stela •: ❑Out ol•stete JAIL NO. .. Pl.OiD HYea No Unknown COURT CASE -NO. • IDS NO.. - AGENCY CODE �/ 01 MUNICIPAL:P.D. DEF. ID NO. MOPD RECORDS AND ID NO. - .... -. • STUDENT ID NO. GANG ACTMT RELATED ARREST CM FRAUD RELATED ARREST INT/ARREST AFFI DEFEND TS NAME (LAST, FIR $TJ/�1M. (DOLE) - - /� 1, �.�(.� �. - Asi-i-L-CY .. I `. ALAS and for STREET NAME. ` .. SIGNAL: i El T El ❑300 ❑,50 ❑200DOB ( /YYn . O / 11 � AGE �s(Je RACE . � S ❑Wspanic _:. HIsppnic-,,;,;, ,. 1. ETHNICITY -HE Hr1 .. WE HT_. R. COLOR HAI .LENGTH HAI .STYLE EYES ES FACIAL HAIR TEET0 H- :. SCARS, TATTOOS„UNIQUE PHYSICAFE RES (Location, Type. Description) .. ,.... PUCE OF BIRTH (City, Stata/Country): LOCAL ADDRESS (Street, Apt. Number) -- .. .. .. ...... (City)... ' , - -- (State) - .. • (Zip) " .. PHONE .. \ .. ..................CITIZZE/N�SHHIP.._... .... -...__ CI PERMANENT ADORES (S 3Lzo eet, Apt. Number) ❑ HOM E 0 UNKNOWN (City) (State/Country) (Zip) rreL Gars eEive,< x ?'so► PHONE ��g6,�f39oo OCCUPATION s- o -- . ❑ BUSINESS OR CI-400L NAME AND ADDRESS(Street) ry(�, (City)(State/Country) (Zp) 1Vll\/0t. D. Ncp`2:"....p.s R� PEE (. SOURCE: L ❑Verbal❑ T.... ..A-��..v.{ ._ DRIVER'S LICENSE NUMBER / STATE //�� I go/4 �//�, . .. ....�/,� V `Q l -[_ '.: _..,.. (�/7........ . IAL SECURITY NO. ._..__. .... _.t.�. /] �j-/'�J� �� .. I:...V � WEAPON IZED? Type ❑ Y ... .. .., . Jo. �. _ .. .�.. ..ADDRESS If Def. has Concealed Weapons Permit. .P.ERMITfl W- .. .; ..-..... , INDICATION OF: Y N UNK Alcohol influence ❑ Drug. influence: ❑ ARREST DA (MM/DD ) -. 11 .0.(¢2A) . 1 ARREST TIME (HHMM) 6.3 / 0_. ARREST ATION (include nart�of ess). • a' Vv_ Do �� �� � �..........-. GRID CO-OEFEN ANT NAME (Last, First, Middle) 1:. ..... ... .. ... ... ... ...... .. ... .. .... .... ...., DOB (MM/DDIYYW) - -:. ..._._. _.. .-. ..... -. ._. .. ... .. ❑ IN CUSTODY 0 FELONY ❑JUVENILE .❑. AT.LARGE..._.;❑.DV _... EA .. O. MISDEMEANOR CO-DEFENDANT NAME (Last, First, Middle)... .. .. ... .... _... .. . . ... .... 2................................................................... ...... ... .. DOB (MM/OD/YYYY) ...........................IN ..._.... ...... ... ..... ,. ... .... . - ....-„ . CUSTODY" 0 -FELONY' "0-JUVENILE..... ' . .. V ...... . . ❑.AT LARGE - . ❑ D -�.❑ MISDEMEANOR CO-DEFENDANT NAME (Last, First, Middle) A- �i 3. DOB (MM/OD/YYYY) 0 IN CUSTODY 0 FELONY 0 JUVENILE 0 AT LARGE... ❑ DV 0 MISDEMEANOR 0 JDy only ❑.Parent (Name) . .(Street -Api Number) • • (City) • .. (Stale/Country) •:' (Zip) .(Phone) .. Contacted? ❑ Guardian \ .) o / ❑ Foster Care ❑ N . Xi 'CHARGES CHARGE AS: COUNTS FL STATUTE NUMBER - VIOL OF SECT COOEOF - •UCR DV - WARRANT TYPE OR TRAFFIC CITATION .. /_ P.S. 1. 171;e2r .. ... .❑ ORD 3'. 9 ‘> ! 7 3 (A .. .. - ...: OAC ❑CAPIAS:. OBW 0FW.❑PWOJUVPU OAW C❑ SE RaWRIT.�ss X ❑ F.S. 2. .. .. .. 0 ORD OAC ❑CAPIAS ❑BW OFW ❑PW ❑JW PU OAW ❑DVW ❑WRR CASE 0: - - - ❑ F.S. 3. ❑ ORO - - CAC ❑CAPIAS OBW ❑Fie ❑Pie❑JW PU OAW ❑DVW ❑WRR ... - CASE#:. - ... . .. :- 0 F.S. 4. ❑ oRD - OAC ❑CAPIAS OBW OFW ❑PWOJUVPU OAW ❑DVW ❑WRR CASE #r The undersigned certifies and swears that he/she has just and reasonable grounds to believe, and does believe -that the above named Defendant committed the followi • . violation 0nthe U/dayof ."°V 20"9.. ,aO NV-(HHMM) at Ock.kApQi c,.(n✓bii-,.'.3.... oflaw: ... ... .. .- (Narrative, be specific) . .. -. (Location. include name of business) -.. p enacu,11 iQs obs rlre d ;v o_ blc�.c r bete. - Soc�-k.CaY-0 irtc3. T *. `I cU cOlt - SOo+Lo00nG1 c) h rnrsi-1 c r,k S i✓rQ ± -:-17 e; -(, r ,v 1-00,! .O" _ n nQ, ivc.. r'or,,) Crt.k • . P, P..., T' tdo S ,A-n OA reA .SvwtiS T 0323 QK • C r,s,,,A, 4 v @. (').i'�iA. �-[J mrM ter? ire. Q . I G-�.c . a Gip�1 n s' i Q Ct 94 .-- c'r U� k C . cA prr I I &4-rnr,- C, .nr- Q ��C�CCiu �. �rn'(t;)' no '1 fc)pri :r I,)' .T t 4I 1-\(1r hCV �� . E �na� . mQ. [-.Pr'�1r,'Orme, . l&c . .>,•NLP . AI 1,,3c,C ff -.:1,rt'-sa ,r F.A. 49-1sr1 �00. ).0. L. � f cl,rb�°r,�Y•\ c,Ty,., ,ec7 •,?-6Dor�.t 5 ii- . HOLD FOR OTHER AGENCY . VERIFIED BY Name OUTD0 .griMND',HFARING. eDOn NOT BOND OUT (Ot t�cer•,•Aiitst isPpear at•Bond Hearing). _re , .1> I understand that should I:wiNfufy tag to appear before the. Court as ❑ _ may be l courtrand ba arrany this t for ce tmy arrestr shall be issued IFr Furthermore, contempt a date, t - S7 MENT IS TRUE _i (o 'yr► SWORN •TO.ANDSDBSCRIBED BEFORE ME, r `S'".,""''^" r ' .agree that notice concerningthe tree and piece of all court hearvtgs shook be sent to the above address. 1 agree that it is responsibilitytoCourtnotify ? ! r 7 r ) THE UNDERSIGNED'A ORI THIS: Juvenile Division) eddressanges anytime that my 1? _ Submitted 0��.AR •W 46 N - - -i, , COURT ID NUMBER/LOC. CODE 'DAY `� ,� You need not appear in court, but must Cornply with tY hereofinto the pub i, sy®c,-�"nstrucGons on the reverse side = ' Ol itt4P0 r record in connection wit) NArylalPrinle/9 n \ n, {� f / : 7 AGENC NAME �" // �> /� Y / 1 __ .. �y of �mo�' MrP ic 24)i .Signature of Defendant / Juvenile and Parent or Gua ' item D1.1 an OI-28-in • Priscilla A. Thompson OBTS NUMBER JAIL NO. COMPLAINT/ARREST AFFIDAVIT POUCECASE No. CONTINUATION 1 /104—3.51 779 COURT CASE NO. IDS NO. AGENCY CODE 49/ MUNICIPAL P.D. DEF. ID NO. MOPD RECORDS AND ID NO. DEFENDANT'S NAME (LAST, FIRST, MIDDLE) 1- L -er M g-6-u_pr 4 ADDITIONAL CO-DEFENDANT NAME (Last, F4s1, Middle) 4. DOB (MM/DD/YYYY) DOB (MMIDD/YY Y) Z ICrir7 ❑ IN CUSTODY 0 FELONY 0 JUVENILE 0 AT LARGE 0 DV 0 MISDEMEANOR ADDITIONAL CO-DEFENDANT NAME (Last, First, Middle) 5. DOB (MAWD/Y1'Y_Y) ❑ IN CUSTODY 0 FELONY ❑ JUVENILE ❑ AT LARGE 0 DV 0 MISDEMEANOR ADDITIONAL CHARGES CHARGE AS: COUNTS FL STATUTE NUMBER VIOL. OF SECT CODE OF UCR DV WARRANT TYPE OR TRAFFIC CITATION ❑ F.S. 5. ❑ ORD OAC OCAPIAS OBW OFW ❑PW OJUV PU OAW ODVW OWRIT CASE 9: ❑ F.S. 6. ❑ ORD OAC OCAPIAS OBW DEW OPW ❑JW PU OAW ODVW OWRIT CASE 9: 7. ❑ F.S. 0 ORD 8. 0 F.S. 0 ORD c-) 0 TD N m cn -n -n C') 0 DAC OCAPIAS OBW OFW OPw OJIN PU OAW Z ODVW OWRIT CASE 9: — C DAC OCAPIAS OBW OFW (DPW OJw PU PAW ODVW OWRIT CASE 9: 771-5 5f51 t s - w iivm/"Jis-relcr,V firg7 ✓�� V7t' -t s s. Z A T9 v o9Y� 7,2(4-rJ5� VL' f D&FsS r45 0 z 0 0 4 Submitted into the public record in connection with item D!.1. on 01-28-10 Priscilla A. Thompson , City Clerk ' I PAGE 74,;7— HOLD FOR OTHER AGENCY VERIFIED BY Name: ❑ HOLD FORFBONO HEARING. DO NOT BOND OUT (Offcer,MnstrAppear-at:Bond Hearing). ❑ I understand that should I willfully fail to appear before the court as required by this notice to appear that I may be held in contempt of court and a warrant for my arrest shall be issued. Furthermore, I agree that notice conceming the time, date, and place of all court hearings should be sent to the above address. I agree that it is my responsibility to notify Clerk of the Court (Juveniles notify Juvenile Division) anytime that my address changes. You need not appear in court, but must comply with the instructions on the reverse side hereof. I SWEAR THAT THE ABOVE STATEMENT IS TRUE AND CORRECT. /V/ngS� - ; - SWORN TOD. ANSI2BSCRIDED BEFORE ME, TH E UNDERSIGNE DTkiOPITY THIS DAY OF ':\^' . r `.=2-6,90 OF cR'S / COMPLA�lf S SIGNATURE COURT ID NUMBER/CZZ CODE .�+�} C'`Z' `.,' Signature of Defendant /Juvenile and Parent or Guardian AM (Printed) J AGENCY NAME Deputy of the Cburtor d rp-PlibIic �!y/ 32.02.09-9 Rev. 05/06 Submitted into the public record in connection with item DI.1 on 01-28-10 Priscilla A. Thompson City Clerk 1 FLORIDA UNIFORM TRAFFIC CITATION In the court designated below the undersigned certifies that he/she has just and reasonable grounds to believe and does believe that on: Citation #i: 0323-RQK 2 County Code: 01 City Code: 066 Agency Type: pD County: MIAMI-DADE City: MIAMI Date/Time: FRI 11/08/2009 02:55 AM VIOLATOR First Name: MEGHAN Middle:ASHLEY Last: HAM DOB: 04/29/1987 Address: 3220 HOFFMEYER RD LOT 5 City: FLORENCE State: SC Zip: 29501-7514 Telephone: Race: B Sex: F Hgt: 505 DL #/: 100105994 DL State: SC Lic. Expires: 2018 CDL: N Ethnicity: Class: D Diff Addr. on DL: N REGISTRATION _ Yr. Veh: 2003 Color: BLK Make: FORD Style: 40 Comm. M. Veh.: N Veh. Tag: BYW206 Trailer Tag: Yr. Tag Expires: 2010 State: FL Plac. Haz. Mat: N 'Upon a Public Street or Highway or Other Location Namely; OAK AVE & MATILDA ST Located Ft. Miles Of Node Did unlawfully commit the following Offense, In violation of State Statute, ;ONE WAY STREET - DRIVING WRONG WAY 318.099(2) Actual Speed: Posted Speed: Companion Cit.: N Crash: N Prop. Darn. N Prop. Dam. Amt.: Aggressive Driv: N ' Injury: N Ser. Injury: N Fatal: N Red Light/Stop Sign: N Driving Under the Influence of Alcoholic Beverages, Chemical, or Controlled Substances, Driving/Actual Physical Control While Impaired, or Driving/Actual Physical Control with Unlawful BloodAhine Alcohol Level Bal.: - INFRACTION, COURT NOT REQUIRED SEE MAILER WWW.MIAMI-DADECLERK.COM 305-275-1111 Arrest Delivered To: On: Court Date: Court Time: Fine: 179.00 I AGREE AND PROMISE TO COMPLY AND ANSWER TO THE CHARGES AND INSTRUCTIONS SPECIFIED IN THIS CITATION. WILLFUL REFUSAL TO.ACCEPT AND SIGN THE CITATION MAY RESULT IN ARREST. I UNDERSTAND MY SIGNATURE ISNOT AN ADMISSION OF GUILT OR WAIVER OF RIGHTS. IF YOU NEED REASONABLE FACILITY ACCOMMODATIONS TO COMPLY WITH THIS CITATION, CONTACT THE CLERK OF THE COURT. Signature of Defendant: x Signature of Officer: Officer name: RODRIGUEZ / / Officer ID: 6177 Case number: Troop/Unit: / Misc: Agency Name: MIAMI POLICE 1 asNaar"r k1�to4 8ri0Z $Z'b0 S37OIH8/ lo1Ot! �O 1N3i4131h'd90 lion rZ $30Nn 'Li �H` Q :3. Hines c a.Ycf M 1d v vv/ ecZycjvg CM W APPLr5&E) /✓lf12")- ❑ (1) F.H.P. (2) P.D. ❑(3) S.O. ❑(4) OTHER 4,7P13 AGENCY /f�' .. _ N THEC ART ITESGMNTBD BELOW TIE 5) .ElEt® �6 iTFTHATIHTE ...- HAS ANTO ASST O RFfun F [MUMS I ElEVE AND CCES B13EVE THAT ON COMPLAINT (RETAINED BY COURT) r: 0T TT +LtsT ®'w. P.M. 'STREET i -ELD- 2 ✓ st z f75/Y DA BERK 1 101E f 10 q STYLE �S S 4r,icf.. 1 I IFC I LHaa Nm0 ❑ F PLACARDED HAZARCCUS WTEPoAL'K' HEE 0 ❑ TRAILSR-TAG NCL F 03MPMEOMI OTATON(S) . • 'X HERE • SIRES N - S C 'i- 1- FCOY NIEW OTADOSISI x 9E ❑ DID UNLAWFULLY. COMMIT THE OFFENSE DE DRWD(6 UNDE1 THE INFLUENCE OF. ALCOHOLIC. BEVERAGES, CHEMICAL OR CONTROLLEDSUBSTANCES; DID ORIME, 0R WAS IN ACTUAL PHYSICAL -CONTROL- OF A YLRLCLE,`, WHREN F UNDER THE INFLUCE OF AW- 1.00HOUC,BEYEAyOHE A6Nt0AL SUBSTMlCHCONTROLLED SUBSTAI0E.n EXTER--.'NORMAL FACULTIES-WFFE IMPARTED; OR WITH A BLOOD OR BREATH ALCOHOL LEVEL OF it OR ABOVE -OF .. •— ..: • ... • COWAB(i5 PERTANNC TO OFFENSE (IiA S1ATE STATUTE ❑ Af(3iERSIVE SRER .SECIICN ❑ YES ONAAGE TO OTHER PROPERTY ❑ s'ES S INJURY TO ANOI�EN 'NTTER SEROUS BODILY Kure TO ANOTHER El YES .AO ❑ YES : O:.. . THIS IS A CRIMINAL. VIOLATION, COURT APPEARANCE REQUIRED, AS INDICATED BELOW,: COURT DATE -771 FATOL ❑YE5 LJ NO 2556.-XED w< 2 COURT AIID LOCATION DELIVERED TO R NO PR0N15E TO COMPLY AND ANSWER TO THE CHARGES ANO INSTRUCTIONS SPECIFIED N THIS ORATION. WILLFUL LFUL REFUSAL TO ACCEPT AND SIGN THE CRATOH L ".RESULT IN ARREST. I UNDERSTAND NY SIGNATURE S NOT AN A0141551011 OF.GUILT OR WAIVER OF,RIGHTS. IF YOU !IUD REASONABLE FACLITY ACCODUODATONS TO COUPLYWRII THIS CITATION, CONTACT THE CLERK OF THE COURT.. ' GATE .1/ - V D9 A SIG.. TUR F VIOLATOR r CTIVE INIMtDIATELY, Y R DRIVING PRIVU E IS SUSPENDED/DIS I I^'_:^'[u r 05 DRIVING WITH AN UNLAWFUL eL R BR TH ALCOHe - THIS SUSPENSION/DISOUAURCATION IS FOR A PERIOD OF SIX MONTHS IF THIS IS TH' IOLATION OF DRIVING WfTH UNLAWFUL BLOOD OR - BREATH ALCOHOL LEVEL OR ONE YEARIF PREVIOUSLY -SUSPENDED OR DISQUALIFIED FOR DRIVING WITH AN UNLAWFUL BLOOD OR BREATH ALCOHOL LEVEL WHEN OPERATING A CMV, YOUR COMMERCIAL DRIVER LICENSE/PRIVILEGE WILL ALSO BE DISQUALIFIED FOR THE SAME PERIOD OF TIME AS THE SUSPENSION. ❑ REFUSAL TO SUBMIT TO LAWFUL BREATH, BL000 OR URINE TEST F.S. 322.2615. THIS SUSPENSION -IS FOR A PERIOD OF ONE YEAR IF THIS IS A FIRST REFUSAL OR 18 MONTHS IF PREVIOUSLY SUSPENDED FOR THIS OFFENSE WHEN OPERATING A CMV, YOUR COMMERCIAL DRIVER LICENSE/PRIVILEGE WILL ALSO BE DISQUALIFIED FOR A PERIOD OF ONE YEAR FOR A FIRST REFUSAL OR PERMANENTLY 'FOR A SECOND REFUSAL WHILE OPERATI CMV, . - LICENSE SURRENDERED? 0 NO REASON ELIGIBLE FOR PERMIT? VYES 0 NO REASON- ' UNLESS INELIGIBLE, THIS CITATION SHALL SERVE AS -A TEMPORARY- DRIVER LICENSE AND WILL EXPIRE AT MIDNIGHT ON -THE 10TH DAY FOLLOWING THE DATE OF SUSPENSION. AT THE BUREAU OF ADMINISTRATIVE REVIEWS OFFICE, YOU MAY REQUEST, WITHIN 10 DAYS AFTER THE DATE OF SUSPENSION, A REVIEW OF SUSPENSION BY THE DEPARTMENT OF HIG =Y SA ICLES. SEE REVERSE SIDE s3a SIGMA HSMV 75904 (Rev. MO TROOP RANT 1 VEHICLE LOCATION BEF -REMOVAIir. .. DESTINATION OF TOWED VEHICLE • R SO. F RTO INGVEHICLE CITY OF MIAMI POLICE DEPARTMENT' 400 N.W. 2 Avenue-;; VEHICLE STORAGE RECEIPT WRECKER TIME ON;SCENE o -' WREFT SCEECKERTIMNEE L .CIS IBM - NOTIFY CIS 241-HOUR-;DESK. EXT 6510:., DATE�� TIME4 NU B 410, TOWING SERVICE AUTHORIZATION TRANSMISSION LINKAGE DISCONNECT/CONNECT,. DOLLIES FLATBED RATE, (WHEN DOLLIES_ NEEDED) • CABLE WINCHING TIME • WAITING/WORKINGTIME.(AFTER FIRST 30 MINS) TIME'= USED _ YEAR DAMAGED/MISSING VEHICLE PARTS HOOD TRUNK FENDER (S) -WHEEL (S) WINDOW (S), TIRE (S) BATTERY ALTERNATOR LIGHTS DAMAGED yEp. NO. RADIO Q SPARETIRE TAPE -DECK _ - O MAG WHEELS MIRRORS O , HUB CAPS Y FOG LIGHTS Q KEV IN IGNITION TRUNK LOCKED ,/�! - Q - O NERSHIP PAPERS, PERSS.ijROPERTY: `�/� /0rt4v6 -_ EVIDENCE VALUABLE PROPERTY RECEIPT NO. AREA DR VEHICLE -DAMAGE 16. Undercarriage 17,-Overturn 18.Tolaled NO ,O WE, THE UNDERSIGNED OFFICER AND TOW TRUCK DRIVER, HEREBY CERTIFY THAT "THE. ABOVE LISTED .JOINT 'PROPERTY INVENJj3RY IS CORRECT TO THE BEST OF OUR KNOWLEDGE:f 1TOW, FIRMS NAME - .. Sfi IMPOUNDING OFFICER ADDRESS- _,-. DRIVER • LICENSE NUMBER NCIC RESULTS OPERATORS' NAME CITY STATE'. (O CALLL NUM ER A3OAT11NF. MATION • PERATOR'S.NAME E:GISTERED -OWNER STATE • SG_ AUTHORIZING -NAME & IBMB. VERIFIED.BY REGISTRATION C • ON -SCENE VEHIC •.CLAIM CHECK NO. r. 0 CASE', COLOR• 'YEAR REGISTRATION NO. .. RECORD. CHECK- O-t .-. DATE i7.., • YR.. VEHICLE-PROCESSED=BY RELEASE Submitted into the public record in connection with item DI.1 on 01-28-10 Priscilla A. Thompson City Clerk 44 02.36 (REV. 6 85) PROPERTY & EVIDENCE BUREAU tt `. �_ M,�City of Miamirecord Department i Submitted into the public , in connection withPolice item D1.1 on 01-28-10 07.,0 FIELD INTERROGATION FORM • Priscilla A. Thompson • City Clerk FIVO Only ❑ Juvenile ❑ Arrest LOCATION TYPE: ❑ 1 Residence -Single ❑ 12 Drug Store/Hospital - ❑ 23 Construction Site ❑ 2 Apartment / Condo ❑ 13 Bank/Financial Inst. ❑ 24 Other Structure ❑ 3 Residence -Other ❑ 14 Commercial Building i] 25 Parking Lot/Garage ❑ 4 Hotel / Motel ❑ 15 Industrial /Mfg. z6 Highway/Roadway ❑ 5 Convenience Store ❑ 16 Storage 1327 Park/Field U 6 Gas Station ❑ 17. Govnt./Public Building ❑ 28 Lake/Waterway ❑ 7 Liquor Sales ❑ 18 School / University ❑ 29 Motor Vehicle ❑ 8 Bar / Nightclub ❑ 19 Jail/Prison ❑ 30 Other Mobile ❑ 9 Supermarket ❑ 20 Religious Building ❑ 99 Other Known ❑ 10 Dept./Discount Store ❑ 21 Airport ❑ 11 Specialty Store ❑ 22 Bus/Rail Terminal Incident(�Report No.• — 7� C(t(0) Location of Incid t: �r 62 �vh�t000?C D 11 to / Time / ay i '�4` It 6700 Fe_( L s Name, First Name, Middle Name: 1M MleV Residence Address (Street,City,. State, Zip):. 32-70 i wFCY-e 4_0 L�-}5-2 Residence Phone: 6,6, ,f43gc0/ Business Phone: Business Address (Street, City, State, Zip): Occupation:p0(i sC ) z 561 Injured: ❑ Y N ❑ Fatal Citizenship: W"As Nickname: . t4 Adult / Juv.: -Aa, -, DO Age' '--- -g--`6 Race / Sex: 1 Hei s Weight: 1(S - E e Color: 1 Hair Color: g i t/� Clothing, Jewelry, Mannerisms, Characteristics: Scars, Marks, Tattoos, Deformities (Describe Location On Body): Hair Length: Hair Style: Facial Hai{: Co IxAio/n": Teeth: 1 Demeanor: Speech: R / L Handed: Build: (.9��1( C,(P p C N tN_ C h, .) .( Alias: NA Social Security o.: Drivers License No.: ate: Other Identification: Disposition: ❑ Ward - D ❑ JAC ❑ Will Appear ❑ Guardia Jail ❑ Other �' Gang Name: Subject Was: \\ 13 Passenger ❑ Bicycle river El On Foot 0 Other V.I.N.: -'' I *I�J3 1U (QS7S3 Decal No.: 13 W Zo Make: I? () Model: —au cuS Year Z�3 Bo y Style: L 1e�s No.: �`(I � (p License Year: 2� C t� License State: So �-�, Cat ea 1J�4 Vehicle Top Color: Vehicle Bgtt�Color: l Unique Vehicle Features: Additionaieh� Description: Tag Comes Back To (Name, Address, State, etc.): Weapon Type: , I (A___ Caliber / Gauge: Make: Serial No.: Charges Attempted: Charges Committed: Drug Activity:b ft Drug Type: �+ �J /1C-CV t��7/ Companions / Co -Defendants (Include Name, DOB, LKA): Offcer Na el). /, b,k16Y(16Z.Officer PIN: Radio Call N • Number Of Arrests This Incident: Number Of ompanions This Incident: D PD/FO 811 Rev. 11/05 CD 0 3 'ill, 0 : ,,-4;,. City of Miami Arrest Gate: /l- 09 ArrE Tn-mC. 03f0 o 1 (ci i= l_J }� Police Department o ' Arrest Location: -02 7 /1/79150. .Pcz f s �'-...:- D.U.L. TEST REPORT Miami Police Case No.: Citation No.: 1-�, 3 -0 , Page 1 of 2 O7/JO - 3.c1799 2,531 -x t t` hject's Name (Last, First, MI): Other Dept./ Case No.: DOB: mo./dalyr. y Zq i'7 Ale: zz Sex: Race: 1? Weight: ) 2D . Height: S s Arrest Test Site: ,4 C M n PPLZ .. Arresting Officer Name, V4 .4d , CLOTHING I.D.it, Agency): . • 0 ' S /V) PT1—f) . OBSERVaTONS:. Describe: /tZ-577 I�-�/ B l •y t-L/, 7L-19,-,S. Breath Test Site: Z Z tra l✓. E, -14 ST, r } V (Type & EL ii 5/ir417A-7. Color) Condition: D DISORDERLY D DISARRANGED D SOILED D MUSSED (Describe): 01 ORDERLY BREATH ❑ NORMAL 121 ODOR OF ALCOHOLIC BEVERAGE ❑ CHEMICAL ODOR ❑ OTHER: ATTITUDE ❑ EXCITED D HILARIOUS D TALKATIVE ❑ CAREFREE i . SLEEPY D COOPERATIVE ❑ INDIFFERENT 0 INSULTING D COCKY D POLITE ❑ PROFANITY drUNCOOPERATiVE COLOR OF FACE 0 PALE .12FLUSHED 0 NORMAL ❑ OTHER: EYES Corrective Lenses: ❑ NONE Co GLASSES 0 CONTACTS, if so: ❑ Hard ❑ Soft egi BLOODSHOT ❑ WATERY 0 NORMAL Blindness: ('NONE 0 L.EYE ❑ R.EYE PUPILS ❑ NOT EQUAL SIZE ❑ CONSTRICTED 'DILATED ❑ NORMAL Tracking:0 EQUAL ❑ UNEQUAL UNUSUAL ACTIONS ❑ HICCOUGHING 4 BELCHING ❑ VOMITING ❑ FIGHTING ❑ CRYING ❑ LAUGHING ❑ NONE SPEECH 0 NOT UNDERSTANDABLE a MUMBLED ❑ SLURRED gif MUSH MOUTHED ❑ THICK TONGUED ❑ STUTTERED 0 ACCENT 0 FAIR ❑ GOOD OSLOW 0 CONFUSED ❑ RAPID --0 LOW ❑ RASPY `.PSYCHOPHYSICAL.EVALUATIONS/PERFORMANCE TESTS -. (only if certified to use) HORIZONTAL GAZE NYSTAGMUS LE WALK AND TURN TEST ❑ 1. Loses balance during instructions. *111*°--% 2.Starts beforetodo so. bftold I Q ROMBERG BALANCE (Time Estimation) 1. Does not .-----. maintain .-----. Cannot smoothly follow a moving object. . Distinct nystagmus at Maximum Deviation. 13. Onset occurs before(count 45° degrees. ❑ 3. Stops walking or pauses to regain Q balance. ❑ 4. Doesn't touch heel to toe. (Leaves 3 9 more than 1/2 inch space) ❑ 5, Steps off line one or two times this only once) a f eyes closed. 2. Sways direction manner. �3. Uses arm(s) 2(4. Time estimation: in any or for balance. for 30 seconds. RIG�IT 1. Cannot smoothly follow 0 6. Raises one or both arms six or more inches to maintain balance. A e ❑ Does not turn correctly or loses t ID 5. Cannot do test. a moving object. balance during tum. II Distinct nystagmus at Maximum Deviation. 3. Onset occurs before 45° degrees.' VERTICAL NYST MUS • ❑ Yes 6 No ❑ 8. Takes more or less than nine steps in each direction. _ 3 9 9. Cannot do test. (Steps off line a three or more times or is in danger of falling and cannot do test.) gr Describe Turn.❑ FINGER TO NOSE Does not i6 2. Misses ❑ 3. Uses wrong 4. Does not TEST maintain eyes closed. tip of nose with tip of index finger. hand when directed. remove finger. � r� Type of Footware: Tr-� ❑ 5. Cannot do test. R ONE LEG STAND L R 1 R 1. Sways while balancing on one leg. ^ 0 z. liaises arm(s) more man six mcnes to maintain Daiance. � ❑ I 3. Hops on one leg to maintain balance. 'f (l' L \lli R 4. Puts foot down one or two times during 30 sec. period. 10( 0 '5. Cannot do test. (Puts foot down three or more times, or loses balance nearly falling.) Draw lines to spots touched D i PD/FO 808a Rev. 02/00 i Distribution: White - Records; Canary - State Attorney's Office; Pink - D.H.S.M.V.; Goldenrod - Officer's Copy. D.U.I. TEST REPORT Pab_ of 2 Citation # Transporting Officer(s): 12► Subject's f Transportation Time:03 ! 7 Arrival Time: D3Z' Time Of First Observation. 0 Ta_5-- Time DRE/DART Notified: Time Of Completed Examination• If DRE/DART Not Notified, Why7• • INTERVIEWhn(Quote Answers) • Subject Advised 01 Miranda Warnings: Date: II-6-V l Time 0-3Sb By: V. Are you ill? ❑ YES D NO Nature of illness? Taking medicine? ❑ YES ❑ NO What kind? Last taken? Taking illegal drugs? ❑ YES ❑ NO What kind? Last taken? Any physical disabilities? ❑ YES ❑ NO What kind? Are you injured? Type of injury? Do you have false teeth? ❑ YES ❑ NO A glass e Artificial limb? ❑ YES D NO Under the care of a Doctor or Dentist? ❑ YES ❑ NO Name. Are you diabetic or epileptic? ❑ YES ❑ NO Take insulin? ❑ YES ❑ NO Are there signs of Type• Any previous head injury? ❑ YENO When? Type MEDIC ALERT ID pres Time of last meal? What was eaten? How long? What were you doing in the re prior to Have you been drinking? ❑ YES D NO Wh- ? Time started? Time finished la r • •k` Where were you drinking? Were you operating a vehicle (or vessel) at Going to? ere y ❑ NO 0 now? ee to four hours before that? /S ❑ NO ❑NO joky? ❑ YES ❑ NO lergies? ❑ YES ❑ NO 'much? Size of drink? Actual Time: op (crash)? ❑ YES D NO Coming from? nv. d in a crash today? ❑ YES D NO Where? Do you feel the effects of the ohol? ❑ YES NO Drugs? ❑ YES ❑ NO At the time you were driving? ❑ YES ❑ NO If yes, how did it affe; 'ou? Do you feel impaired, high, or buzzed? ❑ YES ❑ NO Describe this -= ing? Have you had anything to eat or drink since the arrest (crash)? D YES ❑ NO If yes, Breath ? When? Time: Kg How much? SPECIMEN COLLECTED Breath 0 Time: 03S7 Breath ❑ Time: Blood ❑ Time: Urine D Time: Refusal: Breath D YES D NO 0 N/A Urine ❑ YES U NOX) N/A Blood ❑ YES ❑ NO, N/A Reason for refusal: Breath Urine Blood ^� PM Date: I�t 1—Q9 Instrument S/N: 'Q-'I7��g7-- Operator l .-.A- - I D #' 0 / Blood ❑ Time: Unable ❑ YES Explain. PASSENGERS. IN.VEHICLE NAME ADDRESS PHONE CONDITION Did the subject request an independent blood test, as outlined in the Implied Consent? ❑ YESa NO If yes, what arrangements were made for. the subject to obtain the 'ndependent test? (Submitted into the public record in connection with REMARKS: I 01-28-10 item DI.1 on Priscilla A. Thompson City Clerk CONCLUSION: Is the subject's ability to safely operate a vehicle/vessel impaired? tyYES is impaired. 0 NO:, is not impaired. Examiner's Name (Print): Signature I.D. #: Date of Exam.: 0c S// —a7 D PD/FO 808b Rev. 04/00 - Distribution: White - Records; Canar late Attorne : Pink - D.H.S.M.V.: Goldenrod - Officer's Copy. it- FLORIDA DEPARTMENT OF LAW ENFORCEMENT ALCOHOL TESTING PROGRAM BREATH ALCOHOL TEST AFFIDAVIT Instrument Type: Intoxilyzer 8000 Instrument Registered To: MIAMI PD Instrument Serial Number: 80-000872 Software: 8100.27 Date of Test: 11/06/2009 Date of Last Agency Inspection: 10/14/2009 Observation Period Began: 03:25 Subject's Name: MEGHAN A HAM DOB: 04/28/1987 Sex: F The subject was observed for at least twenty -minutes prior to the administration of the breath test to ensure that the subject did not take anything orally and did not regurgitate. Results: Test g/210L Time Diagnostics Check OK 03:46 Air Blank 0.000 03:47 Control Test 0.081 03:47 Air Blank 0.000 03:48 Subject Sample #1 0.220 03:48 Air Blank 0.000 03:49 Air Blank 0.000 03:51 Subject Sample #2 0.227 03:51 Air Blank 0.000 03:52 Control Test 0.079 03:52 Air:Blank 0.000 03:53 Diagnostics Check OK 03:53 Y T Cylinder Lot: 822501I Exp: 08/21/2010 State of Florida, County of 4/0/ ` 4/ ' Z. Personally appeared before me the undersigned authority, who (✓) is personally known to me or ( ) produced as identification, and who after being placed under oath, states: I DAVID M CA.RPENfER , hold a valid Breath Test Operator permit issued by the Florida Department of Law Enforcement, I administered the above breath test to the subject named above in accordance with Chapter 11D-8, Florida Administrative Code, and this form is a true and accurate report of that breath test. Breath Test Operator: Sworn to (or affirmed before me this Date: day of i%7l/Y1s -, 2.17177 .ur/4 Ri�Z /%i Signat re of tary Public -State of Florida Printed Name of Notary Public -State of Florida Note: Pursuant to section 117.10, Florida Statutes, law enforcement officers, correctional officers, traffic accident investigation officers and traffic infraction enforcement officers are notaries public when engaged in the performance of official duties. In accordance with section 316.1934(5), F.S., this completed form is admissible without further authentication and is presumptive proof of the results herein. To be used in accordance with Section 316.1934(5), F.S., and in administrative proceedings pursuant to 322.2615, F.S. FDLE/ATP FORM 38 - MARCH 2004, Ref. 11D-8.007 City of Miami Police Department MIRANDA WARNING / DERECHOS MIRANDA Submitted into the public record in connection with item DI.1 on 01-28-10 City Clerk, Priscilla A. Thompson Miami Police Case Number: Citation Number: a.77/0d-3S" " ° 0Sis 6—X _ y f hj fhg:!.., ar , - ! , � �3 �ENGLISH if l{�lGLE �: I Other Department Case Nurnber: 5 S t M1 :} :.. $,. _ _.. Before you are asked any questions, you must understand the following rights: YE NO 1. You have the right to remain silent and you do not have to talk to. me if you do not wish to do so. You do not have to answer any of my questions. Do you understand that right? 2. Should you talk to me, anything which you might say may be introduced into evidence in court against you. Do you understand that right? 3. If you want a lawyer to be present during questioning, at this time or any time hereafter you are entitled to have the lawyer present. Do you understand that right? 4. If you cannot afford to hire a lawyer, one will be provided for you at no cost if you want one. Do you understand that right? / \-- Knowing these rights, are you now willing to answer my questions without having a lawyer present? \./7 This statement is signed of my own free will without any threats or promises having been made to me. Subject (Print): Signature: Date: Time: Advising Officer (Print . I.D.#: Date: Time: G `i-�—R OS"S—r) II-6-09 o3s'' Witness (Print): ) nature: . I.D.#: r / t L e � Date: (�-t 0 7 Time:[1 {�) o 3$ J/ , l..l ark -� (�/ � ' .ESPAINOL /`SPANISH ` V Antes de que se le haga cualquier pregunta, usted debera comprender los siguientes derechos: SI NO 1. Usted. tiene el derecho de permanecer en silencio y no tiene que hablar conmigo si usted no quiere. Usted no tiene que contestar ninguna de mis preguntas. LComprende este derecho? 2. Si usted habla conmigo, cualquier cosa que usted pudiera decir puede ser presentado como evidencia en corte en contra suya. ,Comprende este derecho? 3. Si usted desea que un abogado este presente, en este momento o de aqui en adelante, usted tiene el derecho de tener un abogado presente. LComprende este derecho? 4. Si usted no tiene los medios para pagar un abogado, uno le sera provisto sin costo a usted, si quiere uno. i,Comprende este derecho? ,Teniendo conocimiento de estos derechos, esta usted dispuesto a contestar mis preguntas sin tener un abogado presente? Esta declaracion esta firmada por mi propia voluntad, sin que se me hayan hecho amenazas o promesas algunas. Sujeto (Escriba): Firma: Fecha: Hora: Agente (Escriba): Firma: I.D.#: Fecha: Hora: Testigo (Escriba): Firma: I.D.#: Fecha: Hora: n I Pn/FO A10 Rev 02/00 I Distribution: White - Records: Canary - State Attornev's Office: Pink - D.H.S.M.V.: Goldenrod -Officer's Coov.