effective communication 3

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VICTIM

INCIDENT NUMBER

OFFENSE INCIDENT DATE AND TIME

SUSPECT/ARREST SUPPLEMENT ARRESTING AGENCY

N A

M E

/D E

S C

R IP

TI V

E S

NO. ADULT JUVENILE UNKNOWN CHECK APPROPRIATE CATEGORY SUSPECT ARRESTEE SUSPECT/ARRESTEE RUNAWAY MISSING OTHER ___________

NAME (Last, First, Middle)

ADDRESS (Street, Apt., City, State, Zip) PHONE

EMPLOYER NAME AND ADDRESS (Street, Apt., City, State, Zip)

PHONE

*AGE/ D.O.B.

*SEX *RACE B A W I U

*HEIGHT *WEIGHT *HAIR *EYES

PLACE OF BIRTH

SSN

ALIAS GANG AFFILIATION

DL#/STATE OCCUPATION/SCHOOL

MARITAL STATUS

SCARS, MARKS, TATOOS

ADDITIONAL DESCRIPTIVES

SUSPECTED OF USING ALCOHOL DRUGS

POTENTIAL INJURIES?

CHARGES FILED? Y N

*

A S

S O

C .

P E

R S

O N

S

A R

R E

S T

IN FO

R M

A TI

O N

JU V

E N

IL E

R U

N A

W A

Y S

/M

IS S

IN G

11/2005

ETHNICITY

*RESIDENT STATUS 1 RESIDENT 2 TOURIST 3 MILITARY 4 STUDENT 5 OTHER (explain) ________________________________________ U UNKNOWN

__ 2

ARRESTEE WAS ARMED WITH

50 POISON 60 EXPLOSIVES 65 FIRE/INCENDIARY DEVICE 70 DRUGS/NARC/SLEEPING PILLS 80 OTHER WEAPON

ARRESTEE ARMED WITH 1. ___

99 NONE 11 FIREARM 12 HANDGUN 12A AUTOMATIC HANDGUN 13 RIFLE 13A FULLY AUTOMATIC RIFLE

REPORTING OFFICER

APPROVING OFFICER

NAME

2.

1.

ARREST/OFFENSE DESCRIPTION

1.

2.

3.

4.

5.

*ARREST DATE TIME

*INCIDENT TRACKING NUMBER

MIRANDA WITNESSED BY:

FINGERPRINTED Y N

FINGERPRINT CAR

*MULTIPLE ARRESTEE SEGMENTS INDIC COUNT ARRESTEE MULTIPLE

PARENT/GUARDIAN NAME AND ADDRES

PARENT/GUARDIAN NAME AND ADDRES

JUV. PARENT/ Y GDN. NOTIFIED N

DATE/TIME NOT

PREVIOUS Y RUN/MISS. N

DATE OF LAST CONTACT

LAST SEEN WEARING

COURT

. _____ 3. _____

13B OTHER FULLY AUTOMATIC FIREARM 14 SHOTGUN 15 OTHER FIREARM 15A SEMI-AUTOMATIC SPORTING RIFLE 15B SEMI-AUTOMATIC ASSAULT FIREARM 15C MACHINE PISTOL

ADDRESS (Street, Apt., City, State, Zip)

2.

1.

*ARREST/OFFENSE CODE

1.

2.

3.

4.

5.

ARREST LOCATION (Street, Apt., City, State, Zip

ARREST DISPOSIT

D NO. PHOTOS TAKEN Y N

NO. TAKE

ATOR ARRESTEE INDICATOR N/A

*AR T

S (Street, Apt., City, State, Zip)

S (Street, Apt., City, State, Zip)

IFIED NOTIFIED BY

DATE OF EMANCIPATION

16 IMITATION FIREARM 17 SIMULATED FIREARM 18 BB/PELLET GUN 20 KNIFE/CUTTING INSTRUMENT 30 BLUNT OBJECT

BADGE NO. DATE

PHONE

2.

1.

F/M & DEGREE WARRANT # *ARREST LARCENY TYPE

1. 1. 1.

2. 2. 2.

3. 3. 3.

4. 4. 4.

5. 5. 5.

23A POCKET PICKING 23B PURSE SNATCHING 23C SHOPLIFTING 23D THEFT FROM BUILDING 23E THEFT FROM COIN-OP MACH. 23F THEFT FROM MOTOR VEHICLE 23G MOTOR VEH. PARTS/ACCESS. 240 THEFT OF MOTOR VEHICLE 23H OTHER: ______________________

)

ION BAIL

TIME READ

N PHOTO ID NO. FBI/BCI#

REST 1 COMPLAINT 3 WARRANT 5 ORDER OF PROTECTION YPE 2 IN-PROGRESS 4 SUMMONS 9 OTHER

PHONE RELATIONSHIP

PHONE RELATIONSHIP

*JUVENILE HANDLED WITHIN THE DEPARTMENT DISPOSITION REFERRED TO OTHER AUTHORITIES

DATE/TIME ENTERED NCIC #

DATE

DATE BADGE NO.

  1. SUSPECTARREST SUPPLEMENT ARRESTING:
  2. AGENCY:
  3. INCIDENT NUMBER:
  4. VICTIM:
  5. OFFENSE:
  6. INCIDENT DATE AND TIME:
  7. NO:
  8. ADULT:
  9. JUVENILE:
  10. UNKNOWN CHECK APPROPRIATE CATEGORY:
  11. SUSPECT: Off
  12. ARRESTEE: Off
  13. SUSPECTARRESTEE: Off
  14. RUNAWAY: Off
  15. MISSING: Off
  16. undefined: Off
  17. OTHER:
  18. Y: Off
  19. N: Off
  20. NAME Last First Middle:
  21. SSN:
  22. ALIAS:
  23. GANG AFFILIATION:
  24. ADDRESS Street Apt City State Zip:
  25. PHONE:
  26. EMPLOYER NAME AND ADDRESS Street Apt City State Zip:
  27. PHONE_2:
  28. PLACE OF BIRTH:
  29. OCCUPATIONSCHOOL:
  30. AGE DOB:
  31. SEX:
  32. DLSTATERow1:
  33. B:
  34. W: Off
  35. I: Off
  36. U: Off
  37. ETHNICITY:
  38. HEIGHT:
  39. WEIGHT:
  40. HAIR:
  41. EYES:
  42. MARITAL STATUS:
  43. SCARS MARKS TATOOS:
  44. ADDITIONAL DESCRIPTIVESRow1:
  45. ALCOHOL: Off
  46. DRUGS: Off
  47. POTENTIAL INJURIES:
  48. 2:
  49. RESIDENT: Off
  50. TOURIST: Off
  51. MILITARY: Off
  52. STUDENT: Off
  53. 5: Off
  54. UNKNOWN: Off
  55. OTHER explain:
  56. 13A:
  57. ADDRESS Street Apt City State Zip_2:
  58. PHONE_3:
  59. 1:
  60. 1_2:
  61. 1_3:
  62. 2_2:
  63. ARRESTOFFENSE CODE:
  64. FM DEGREE:
  65. WARRANT:
  66. 1_4:
  67. 1_5:
  68. 2_3:
  69. 2_4:
  70. 2_5:
  71. 2_6:
  72. 2_7:
  73. 3:
  74. 3_2:
  75. 3_3:
  76. 3_4:
  77. 3_5:
  78. 4:
  79. 4_2:
  80. 4_3:
  81. 4_4:
  82. 4_5:
  83. 5_2:
  84. 5_3:
  85. 5_4:
  86. 5_5:
  87. 5_6:
  88. OTHER_2:
  89. ARREST DATE:
  90. TIME:
  91. 23H:
  92. INCIDENT TRACKING NUMBER:
  93. ARREST DISPOSITION:
  94. BAIL:
  95. MIRANDA WITNESSED BY:
  96. TIME READ:
  97. Y_2: Off
  98. N_2: Off
  99. FINGERPRINT CARD NO:
  100. Y_3: Off
  101. N_3: Off
  102. NO TAKEN:
  103. PHOTO ID NO:
  104. FBIBCI:
  105. COUNT ARRESTEE: Off
  106. MULTIPLE ARRESTEE INDICATOR: Off
  107. NA: Off
  108. COMPLAINT: Off
  109. WARRANT_2: Off
  110. ORDER OF PROTECTION: Off
  111. INPROGRESS: Off
  112. SUMMONS: Off
  113. OTHER_3: Off
  114. N_4: Off
  115. TYPE:
  116. DATETIME NOTIFIED:
  117. REFERRED TO OTHER AUTHORITIES: Off
  118. PARENTGUARDIAN NAME AND ADDRESS Street Apt City State Zip:
  119. RELATIONSHIP:
  120. PHONE_4:
  121. N_5: Off
  122. DATE OF LAST CONTACT:
  123. DATE OF EMANCIPATION:
  124. NCIC:
  125. DATETIME ENTERED:
  126. LAST SEEN WEARING:
  127. REPORTING OFFICER:
  128. BADGE NO:
  129. DATE:
  130. APPROVING OFFICER:
  131. BADGE NO_2:
  132. DATE_2:
  133. COURT:
  134. DATE_3: