Criminal Tech

MERSONVILLE DOMESTIC VIOLENCE REPORT

Defendant’s Name: Last, First, Middle

Summons Number 9002340 The People of the State vs. Case Number _____________

Date of Birth Age Sex Height Weight Build Hair Eyes Race

Residential Address City State Zip Code Home Phone Cell Phone

Business Address

Location of Offense

Charge #1

Description Misdemeanor______ Felony______

Description Misdemeanor______ Felony______

Description Misdemeanor______ Felony______

Statute Number Title

City State Zip Code

City State Zip Code

Zip Code

Business Phone Occupation

Business Address

Victim also Defendant on Cross Complaint Summons Number

Officer _____________________________ID#_________Signature______________________________

Officer _____________________________ID#_________Signature______________________________

Served By: Officer ________________________ID#_________Signature_________________________

THE UNDERSIGNED HAS PROBABLE CAUSE TO BELIEVE THAT THE DEFENDANT COMMITTED THE OFFESE(S) AGAINST THE PEACE AND DIGNITY OF THE PEOPLE OF

THE STATE

____________________________

City State Zip Code Business Phone Occupation

Yes____ No____

Yes____ No____

Location of Custody

Custody Date

Victim’s Name: Last, First, Middle

Weapon Used _____ No Weapon Used _____ Weapon Displayed but Not Used ____

Assault With Weapon ____ Edged Weapon used _____ Firearm Used _________

Blunt Object Used _____ Description of Other Weapon Used_______________

Illegal Street Drugs Used or Suspected ____ Prescription Drug Used or Suspected _____

Alcohol Used _____ Other Unknown Substance Suspected____

Custody Time

Defendant Weapon Use

Defendant Drugs or Alcohol Use

Did Suspect Resist Arrest?

City State

Charge #2 Statute Number Title

Charge #3 Statute Number Title

Residential Address City State Zip Code Home Phone Cell Phone

Date of Birth Age Sex Height Weight Build Hair Eyes Race

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1. Case Name:
2. Case Number:
3. Defendant's Name Last First Middle:
4. Date of Birth:
5. Age:
6. Sex:
7. Height:
8. Weight:
9. Build:
10. Hair:
11. Eyes:
12. Race:
13. Residential Address:
14. City:
15. State:
16. Zip Code:
17. Home Phone:
18. Cell Phone:
19. Business Address:
20. City_2:
21. State_2:
22. Zip Code_2:
23. Business Phone:
24. Occupation:
25. Location of Offense:
26. Charge # 1:
27. Statute Number:
28. Title:
29. Description:
30. Charge # 2:
31. Statute Number_2:
32. Title_2:
33. Description_2:
34. Charge # 3:
35. Statute Number_3:
36. Title_3:
37. Description_3:
38. Location of Custody:
39. Custody Date:
40. Custody Name:
41. Weapon Used:
42. No Weapon Used:
43. Weapon Displayed but Not Used:
44. Assault With Weapon:
45. Edged Weapon used:
46. Firearm Used:
47. Blunt Object Used:
48. Description of Other Weapon Used:
49. Illegal Street Drugs Used or Suspected:
50. Prescription Drug Used or Suspected:
51. Alcohol Used:
52. Other Unknown Substance Suspected:
53. Victim’s Name Last First Middle:
54. Date of Birth_2:
55. Age_2:
56. Sex_2:
57. Height_2:
58. Weight_2:
59. Build_2:
60. Hair_2:
61. Eyes_2:
62. Race_2:
63. Residential Address_2:
64. Home Phone_4:
65. Cell Phone_4:
66. Business Address_2:
67. Occupation_2:
68. Summons Number:
69. Officer:
70. ID#:
71. Officer_2:
72. ID#_2:
73. Officer_3:
74. ID#_3:
75. Business Phone_6:
76. Zip Code_6:
77. State_6:
78. City_6:
79. Zip Code_5:
80. State_5:
81. Zip Code_3:
82. State_3:
83. City_3:
84. City_4:
85. State_4:
86. City_5:
87. Zip Code_4:
88. Signature_2:
89. Signature_1:
90. Signature_3:
91. Misdemeanor Felony: Off
92. Misdemeanor Felony_2: Off
93. Misdemeanor Felony_3: Off
94. VDCComplaint: Off
95. Did Suspect Resist Arrest: Off