HomeMy WebLinkAboutCC 10 CLAIM #88-20 08-15-88~ ~'~.; ~ ........ / 'Inter.-Com DATE: JULY 29, 1988 .. FRO~: $ USJ ECT: ~HONORABLE MAYOR AND CITY COUNCIL CLAINANT: REGGIE RAINEY; D/L: 12/2/87; DATE FILED W/CITY: 3/14/88; CLAIN NO: 88-20; CARL WARREN FILE NO: .~a~nT.~ After investigation and review it is recommended that the above- referenced claim be rejected and the City Clerk directed to give proper notice of the rejection to the claimant and to the claimant's attorney. City Attorney JGR (F4. se) Enclosure: Copy of Claim · CLAIM AGAINST THE CI~ii.~ TUSTIN ('For Damages to Per ~r Personal Property) Received by ',.S. Mail nter-office Mail Over the Counter The law provides generally that a claim must be filed with the. City Clerk of the City of Tustin within 100 days after which the incident or event occurred. Be sure your claim is against the City of Tustin, not another public entity. Where space is insufficient, please use additional paper and identify informa- tion by paragraph number. Completed claims must be mailed or delivered to thc City Clerk, The City of Tustin, 300 Centennial Way, Tustin, California 92680 TO THE HONORABLE MAYOR AND CITY COUNCIL, City of Tustin, California: The undersigned respectfully submits the. following claim and information rela- tive to damage to'persons and/or personal property: 1. NAME OF CLAIMANT: Reqqie RaineY a. ADDRESS OF CLAIMANT: b. PHONE NO: ( c. DATE OF BIRTH: SOCIAL DRIVERS . d. SECURITY NO: e. LICENSE NO: · 2. Name,. telephone and post office address to which claimant desires notices to be sent, if. other than above: Todd W. McWhorterr E.sq.r 207 W. 20th S't., .Santa Aha, CA 92706 · This claim is submitted against: a· The City of Tustin only. The following employee(s) of the City of Tustin only: C · XXX The City of Tus~in and the following employee(s) of the City of Tustin only: see attached report 4. Occurrence or event from which the claim arises: a. DATE: 12/2/87 b. 'TIME: 10:30 p.m. c. PLACE (Exact and spe'cific loca%ion): Edin~er Ave., Irvine, Ca. d. How and under what circumstances did damage or injury occur? Specify the particular occurrence, event, act or omission you claim caused the injury or damage (Use additional paper if necessary). RaiD~V way stoDDed without probable cause, was detained for an .~nreasonable period of time~ and was beaten. e.. What particular action by the City, or its employees, caused the alleged damage or injury? beating, clubbing, kicking, etc.. '5. Gi~e a description ' the injury, property da a or loss so far as is known at the time of this claim. If there wer~ no injuries, sta%o "no injuries# . ~e~ attached medicals 6. Give the name(s) of the City employee(s) causing the damage or injury: see attached 7. Name and address of any other person injured: · none 8. Name and address of the owner of any damaged property: 9. Damages claimed: a. Amount claimed as of this date: b. Estimated amount of future costs: c. Total amount claimed: .~n_nn~ n~ d. Basis for computation of amounts claimed ('include copies of all bills, invoices, estimates, etc.: ~see attached report and medicals 10. Names and addresses of all witnesses, hospitals, doctors, etc.: ao c. , _ d. Any additional information that might be helpful in considering this claim: WARNING: IT IS A CRIMINAL OFFENSE TO FILE A FALSE CLAIM.' (Penal Code Section 72; Insurance Code Section 556.0) I have read the matters and statements made in the above claim and I know the same to be true of my own knowledge, except as to those matters stated to be upon information or .belief and as to such matters I believe the same to be true. I certify under penalty of perjury that the foregoing is TRUe. AND CORRECT. , Executed this llth day of March ., 19 88 , at Tustin, California. Office of the City Clerk, Tustin, California " CLAIMANT ' $ SIGNATURE Revised 8/05/81 JGR:se :R:8/5/81 (A) INITIAL REPORT Patient's Name: Re,glo R~iney Claim/Policy #: Employer: ~o~ai ~-3~ Date of Injury/Onset: ~-','Z.x~87 1. Incident of Injury: On 12/5/87 at approximately 10:45-~1:00 ~atl~nt reports ~h~t he: "was $tJpped by ~olice and h~ reoeated]y ~ith ~,~]~', ~]ubs on this. ~a~e(12/3/87) coming home from work." 2. Patient's Complaints: "Stiffness a-~d sore muscles, sore rib, ', · toe, wrist, shoulOer, back , leg, arms." The patient also complai~'~-~-, c~ inguinal 'pain on the left side. 5. Objective Findings (Examination): Initial consultation and examination was performed on 12/7/87 which was followed by recommended emergency evaluation for trauma sustained: Decreased cervical rang~', o~ motion in ail ranges with severe attendant pain. Decreased lumbar range of motion in all ranges with severe attendant Dain. Foramina Compression Testing is positive bilaterally. Positive Kemos test on the Le~t. Positive Kemps test on the right. Shoulder Depression testing is positive ~-~ the left. Lasegue's Sign is positive bilaterally. Positive Goldwaits t bilaterally. ~abere-Patrick°s Test is positive bilaterally. Positive ~_lsalva test. Positive Cough- Sneeze test. Positive Milgrams test. On 12/18/87 after medical evaluation was performed at Chapman Medical Center the patient reported that they diagnosed a left shoulder separation and a ie~t inguinal hernia, also it was brought to our attention that the patient was suffering from left lateral bone bruises and left side thoracic rib bruises. 4. X-Ray Analysis Summary: CERVICAL SPINE Cervical Hy~olordosis. The patient°s head is tilted to the le~t. Cervical curvature is on the left. The radiographs suggested the presence of mild myospasm · the 'cervical paravertebrai musculature. Multiple views of the cervical Spine revealed no conclusive radiographic evidence of recent fracture or gross osteopathology as visualized. LUMBAR SPINE: Lumbar Hyperlordosis. The ilium is high'on the.~ight. Radiographic analysis of the lumbar spine was negative for recent fracture or gross osteopathology as visualized. 5. D£agnosi.s - ICDA #: 847.0 CERVICAL SPRAIN/STRAIN, +847.2 LUMBAR SPRAIN/STRAIN &. Alternate Summary (Comments): The examination and radiographic finOings support a causal relationship ~ith the history of the a~cident.y T. Disability Data: T~-,~ ~atien~ can perform light work with minimum 2 ture Precision ChiroDrac~ic 2950 N. ~lassell S~reet Orange, CA e26a5 Cent~- Date Completed ,By ATIENT · INSURED (SUBSCRIBER) INFORMATION ':~:~ ~,~: .~ ~"r-V (' ~ J~. PATI~T'S ~x . · p l~3eM :: I~ & /.22'". C' ~ACILITY WHERE ~RVIC[S I~N:~RED fir omer ~ hame er oN,ce) 4 24. A I ..' / 1 c,; 87 ..... ...:_; / ~..;~ .; ..., .. ::..,,:~,/ · . . .. · ~ ~_., !' .....,:::.., :.-..:-,:, . C;:. --~ · ' .. ~' L' :i./:-3 7 ,.--, (: ::/' ~ :~ / c.,.::. ,::,~ i / Z 5 / 8 E', · ;.: . ,.-..) .! .41~D.L"~ ~.RV.U'/...~ Oil ~ll~tlL5 D 97200 OV W/~'t-C'C~',T,O~ (3Amin) i-4 97201 Each add ] 15 .TiiF,, i . ;--,~ i i-._ .... L ' ' " 90020 NF' Ir,' ,~.,.. < c, ) ~-;¢ - - - 97201 ,::;~c:r, aod' I 15 mzn. =xtend~d Re-Exam i-4 .2. :. :*:.,I, (-: ( *:::. I : . : ..' .= "-~1 ~ ~-* ~'..~ -- ,---.I ;"ii -';;:,F" _....;..~ ~; .. I I -4 I · "' -'Ct ,: ','?' I.D.~33-0141118 '~NT NAME 3 C] 70110 4 1'1 70130 e D 70150 70 70160 90 702OO 10 O 70210 11 O 70220 12 ~ 70240 13 ~ 702~ 16 ~ 70330 17 ~ 70360 lB ~ 70380 25 ~ 71010 2~ ~ 71020 2B ~ 2g ~ 71110 30 ~ 71120 9 ~NE 35 ~. ~ 2~ 4~ ~ ~1~4 4e ~ 7~170 50 ~ C ~EMmES - "" '!GE MEDICAL DIAGNOSTIC ~' 293 S. MAIN,. .,.;ET. $1J~TE 1 O0 · ORANGF_,C~LIFOR. N'~ L./~.~/ ~ - ---.:- ~ _ NECK AND CNE~I' F~I ~ ~ (O~) .... N~I B~ .,, ODt,C F~m~ ~ ~ Skull ~e Tem~romandi~r Jt~ B~L N~K ~fl T~ C~t 1 ~ Ch~t 2 v~ ..... R~ U~L Ril~ BiisL Sternum Sterno-Cisvicuisz AND PELVIS, C-S43irm, com134ete IncL Fisv. & ExL ~uml~r JunCt. 8~ ~ 74000 A~?~~gtl ~ (KU8) 83 ~ 74020 ADdomet~.Com~te 87 ~ 74220 88 ~ 74~41 UGI. with KUB 91 ~ 74270 92 ~ 742~ g3 ~ 74~0 Ch~st~m~ Omi '" 111 O 76535 Thy~<l Reel Time 112 r"~ 7~45 ~llst Reel T~ma 113 ~ 767~ ~m~m~e ' 118 O 7~5 ~~lC~e Si~e ' 119 Seoaoll Slue/ L-S Some. limited ~ L-S Same. ~e (Ommu~l ~ Lim#ed Pmv~ Coat,em ~ Sacroiliac Jt~ Corollate Sic, mm&Coccyx 57 O 73~30 Ctmvicle 63~ 73~ EI~ . ' / 64 73~ F~a~ 65 ~ 731~ W~[Limff~ 66 ~ 73110 W~[C~te 67 ~ 73130 Hand 68 ~ 731~ Fi~er{s) 69 ~ 73510 Hi~ Unil. Com~tete 70 ~ 73520 Hi~Bi~L~Petws 72 ~ 73550 Femur. In~. Jr. ~ _ 73 ~ 73562 K~eComolete ' .... 73581 Knee Annr~ra~y. Com01ete ~3590 TiDe & FiOula -~ _ 7~0 An~le. Comolete 77 ~ 73630 F~ot. Comolete /' 78 ~ 73~ F~&Ankle ~: -:: ~3663 Toes ;;:; -- 75821 Ven~m~ UniL Complete ~02 -- 75~23 Ven~ra~ BilaL Complete !'1 76815 ~ Lo=a~iz. ation 123 ~ 7~370 T~t~a~z Utt~nd O NUCLEAR MEDICINE FEE · mi _ ii m 127 E3 78215 LNer & Spleen 128 O 7~223 Hel~toDilmry Ductal 129 O 7~ ~ ~n L~e~ u 1~ ~ 7~ ~~flComp~te 131 ~ ~ ~c B~ Poohng 1~ ~ 7~18 ~ I~&. R~,on. P~ ..... ~2 ~ 7~24 ~ Im~ R~ Peri. (Re~) ..... .~ 6 ~ 787~ ~lm~i~On~ ~; 1~ ~ 787~ ~ Fu~mon Stu~ 124 ~ 7~ ~U~l~eOn~ .... 125 ~ 7~7 ~ Imgi~ MultL ,, 126 ~ ~ T~hn~ium Thyr~ ~n .... H ~RDIO/~ONARY , ,, 139 ~ ~ , ,, J~ ~ ~15 ~ Stre~ Test (TreaOmill} ,- L: ~42 ~ ~274 H~ter MOmtor ECG · ' ~ _ ...~3 ~ ~ M-M~eEc~o · 145 ~ 93~9 2-D. M-Mooe Ec~o:z':~;raOny ~46 ~ 937~9 2-D. M-Mo=e Do==.'e' , 152 ~ ~010 Somromet~-Vit~t C~: =,o~ -- 'm I ~4NV~ V~U~ 148 ~ 93870 Caret;0 Ima; ~Spec: A-.z .. 149 ~ 93890 Anermal StuOy-UoDer Exire~ 150 ~ ~910 A~e, ml SluOy-Lower Ex;rem 151 ~ 9395G Deed Venous Evaluahon MEDICARE Fq:IOVtDER eW9992 , · (714) 771-2281 f'~ % ) i DATE OF SERVICE F j blIICEL.LANEOUI,, 100 O 74741 Hyena lO3 ID 7~xx)' ~ 105 !"9 7~O62 O~ Suwey. ComPete 1~ O 7~ Xe~~m~ Unit 107 156 ~ ~70 Sm~e Troy CT. ~n K ~I~L ~E~PY 157 ~ g71~ 1 A~/1M~.ln~Min. 15g ~ g7101 ~~15Mi~ RELEASE AND ASSIGNMENT: I beret authorize ORANGE MEDICAL DIAGNOSTIC 'I'ER to retea~e any information aCcluireO Ouring ti- course of my examination or treatment. I hereDy authorize Dayment to ORANGE MEDIC.~ DIAGNOSTIC CENTER for the me(tic, al beneh otherwtse DayaDle to me for ~rvices as herein, but not to exceecl the reasorml~e aaa cu ternary charge for tnmr 8ewices. I uncierstand tha am financially r~lx)rmible for ail charges cov~'ecl by this authorizatiort. _ S~gn~tt (Plaint. ~ Parent d Manor) Date DIAGNOSIS CODE: · · . '*~/~-.~ DIAGNOSIS: [~' '''! '" ' :' ~ ['"'~ ! , Reterrmg Physicmn ~' ' ~'~ ?' '-' '-' A(~lr~s TODAY'S CHARGES AMOUNT RECEIVE~ E) CK ~ CR CD O CASH ADJ U STM E NT AMOUNT. OWED s _ ( , o HA~k 3UDI~ 0157K1¢ COUl,iTY OF OI,L^NGI.L; STATE OF CALIFOI<NiA, .. · · ,) ) · ) ) ) ) CuU;~'i iV: O{, u{ ~l~out 12/2/;.;7, and ~iv~, lcl~a, ~i~d poascss ~l~ ir~ru~',~unl ~nd weapon ol :l~e kin~ cummu~Hy ki~own ~s ~,.,bi(i' V; O~, ur about 12/3/J7, ~aia dclc~,aan:, in viul~:iu~, ol Section i~3 ol ~1,= P~l~al Co~e, a M15D~M~ANOic, did w~llully and unlawlully re~, dc~y, ~ld obstruct a pubhc oliic=r in lh~ dbch~rg~ ~d ~ttempt to-di~ci~arae a du~y oi his o~lic~. COUNT Vh On or a~ut i2/2[37, ~i~ det~r,~n[, ~ vioa~ion oi Section ll~7(b) oI the ti~lti~ h~d 5~tety Coa~, a ivIIS~,~EANOt(, did williully ~d u.l~.lully po~&s~ not lnor~ ~h~n'onc uvoir~upois ounce of mariju~. C;IT^,~.~,~ ,.,~,. ~..~.0771t. L~ ^TTACIikD l-ial4E'l'O ^i~{.) INCOiLPOtV. A'rED Hl-~iiii~ BY ~a~'~'~.i.,, 'L ,-',~ ADGITONAi. VIOLATiON.S, COUNT(S) 1~ 11, a: III. tt, c oulc~Gapt(l)'h~reili n~rnuu, m~d :{~l ~id ~eienaants(~) be dealt with ~ccor~na to the 1~'. I declare u~.acr p=,~lt>, of perjury that :t~u IUrcisoin~ is true ,md correct. ,,? / ~ pi' .. ~- ...-;' ;~7-22601 I OR J/,!L USE ONLY Er BOOKING · '~ - '/ "...] ,'.iC~.m, IAL PLEASE c. .,,'-'E ' PRE-BOOKING RECOR[ [ ~ ESC ~ VID ~ ~, ~ OTHER Ir-"] WARRANT ~ME r'-] OR,S£Lr JD OR/OR D COURTORDER D OR/TR - DATE' COM.!.'~ - TIME FINE: $ J J'""""] BOOK AND RELEASE , SPECIFY D ENROUTE D LINE UP ARRESTING OR TRANSPORTING OFFICER COMPLETE LAST FIRST MIDDLE lNG AGENCY BIRTHDATE b - t6-~"1 )DITIONAL A.K.A. OR ,NJURED J TYPE OF ,LLNESS OR ,NJURY YES ~NO ! JRISpICTION J WARRANT AND/OR CASE NUMBER ! ~ARGE 1 ~'~/'"~..~'~v' 4,~-.v ~ CHARGE 4 lARGE 2 -tAR C,,1LE 3 i :ARS. MARKS. TATTOOS. AMPS JEYES BUILD CHARGE5 CHARGE 6 OC.~UPATION COMPLEXION J MARITAL STATUS )DRESS --XT OF KIN: NAME ,'7'/V~ ~t~. , ,,.~'i,-.l CiTY :)DRESS ....~,,,,,,,~ ~') ~.- · j L~..CITY ~o~ ~o · jSOGIAL SECURITY NO.- ELEPHONE NO. 97'- .. STATE ' · J ZIP STATE J ZiP 4PLOYED BY J BUSINESS ADDRESS ,..~--~ -- . ..... ~-.~.,.ll,.'"~l~ll,r' - : :~-- _ -. .... ~ ..... ~ . 11 il , , :FICER'S ADDITIONAL INFORMATION/CHECK BOX IF YOU BELIEVE THE INMATE WILL REQUIRE SPECIAL MANAGEMENT. ~ MEDICAL D MENTAL ~ INTOXICATED ~ PROTECTIVE CUSTODY D HIGH SECURITY r"""} OTHER · I I I II I I III 'ERMIS$ION TO USE TELEPHONE AFTER ARREST (pursuant to penal Coae ~echon 8S~.~) nave been g~ven the opportunity to make three (3) FREE telephone calls within the LOCAL DIALING area, or at MY OWN EXPENSE tJTSIDE me Io:~ chaHncJ area. RECORD OF TELEPHONE CALLS: DESIRED /' Telephone calls COMPLETED - S;GNATURE ~o~e: ~: .. ,;: (, ,,eT, ~Js.aoo o OFFICER .' COURT COPY IRVINE POLICE DEPART;,'~ENT ("' NOTICE TO APPEARt- , ,, ,. -~-- ;, ' .'" . .... o. tcoo- ~, ~-'_Z-- ~,,., ,,.- -....----.---~o""' ----7_~' ~ ~ ~-'c,- "*" - "") H~';"-~(t/c.(~o J///'/~/'1~- 0 R..,o,.,. -% ------- OFFENSE(S) N BE. LIEF. II;X,~..CIJTI;Q JT INVINi ON TN' OATir SHOWN &OOV' IN OII&#Gr C:OI.~NTT, ¢&GIprOftNl& i.D. NO. o ,....o. ~,..,A,,.-...0. ,-.. .......... ,,., mOST B, L, AT THE OR&NG_G_~"'~"~'~,~,4 "~£WPORT BE, ACH CA Tm,/,.re. pHONE:: I$) o s'S'mO o,, o,, mm-on' TN, ..~ 0 OR OTHE:R LOCATION -- [' wRECKED' ipPEo' HAVE YOU ENTERED MISSING, __ i='lABl-I= PARTS IN SVS? ,~ Es n,,o c:]..,,,,o.,, E3'' ITEMS ITEMS NO t ITEMS ITEMS CONOIT ION t EMS TRANSMISSION NGINE '$. s) - iUCBET ,LOCK LEFT FRONT CARIURITORISI sI&T (FRo#TI IGNITION KEY ~ SPIED I i lIGHT FRONT ALTERNATOR SEAT tREARI GISTRATION 4 SPE£O I I LEFT REAR DR. LIBHTSIR ) GENERATOR NUB CAPS IR ) RIGHT REAR I,. Mil AG WHEELS _~, RECOVERED, STORED OR ., ' N N ' ~ D&T[ &ND CASE NOMI[N OF N[pONT IN6 &6[NCY OWN[ ~~~~ CONDITION AND INVENTORY TAPE DECK II | RILL _.----i------- ,.~ ...,,.....,,,......,., .,,...,0.,.,, ....,.o..~ -... ,.[,,,..~,,o...,., ~ p ~; 1.0. HUMBER ARAGE ffTM DA A( kT YEH {SIGNATU! OFFICER ORDERING VEHICLE STORED (SIGNATURE] · i,-~,,~L.,,,L I/C-- ' APPRAISAl-, REI-F. ASE, IFOR OFFICE USE ON]..Y) TELETYPE (DATE AND ~..r.:._.,~£0 NOTICES %EN-~~~ ~(o' iNDICATE N~ASON ~jAVA pROGRAM ~TORAG[ AUT)~OR ITT/CONC£Rk' T IRE AND ' C~RTIFICAT lO · _ .......... ~t~ TO TAKE pOSSESSION OF . 7~-g~ Ur~gina~' Reco~as ~. ?,,~ COov: Tow Comp~nv · ;I:OLEN BICYCLE (PARTS) IROPERTY RECEIPT )EST_RUCTION I C, OF OCCURRENCE ,TIM L/F/M III · lelI I ~ II~/ ii. ...... ~ ' ~: '~' S f') F~ ,ICYCLE (PARTS) Case #_ ,, [~ FOUND MISC. PROPERTY r-I RECOVERED PROPERTY DATE/TIME OCF..:JR RE D " /~'~ .;'~.~[ DESCRIPTIOE: ~ ';:: ' Other __ Banana Color: ~ ~. ,... .... -'"' ~~ "S BIKE LOCKED: RLS BRAKES "'--"-"'"-' ~ ~ ~ ' ~ e --'--' -- - Back Rick - ' ~ Knobby BIKE LOCKED ,.....Chain Guard ~ __Racing White Wall DYES r'lNO __Basket -- Racing Black Wall __ OTher Type: .__.i....- BRAND MODEL LIC. ' ~GE OF BIKE COLORS: FRAME TRIM GRIPS CH. GUARD OTHER THER IDENTIFICATION MARKS;.--- I ETAILS OF OCCURRENCE or PROPERTY DESCRIPTION ' p · ,~ ' E'TIME REPORTED ,-,.~-~· ~.~'t Z..'5 PHONE D.O.B. BUS. PHONE D,O.B. ' ~.. TAPE ADDITIONAL SERIAL NBR. JEWE LR Y PREC. METAI~ $ A B OFFICE FURS EQUIP. $ C E HOUSE- ~n~_~ ~u LIV~ ...... '~ I~~"1 ~AA;~ I M,SC. GOODS TOTAL VALUE H I j K WAS OWNER NOTIFIED? Pp~-~=.RTY ,c..~TU~:';ED TO OWNER ADDRESS "~' ~;,) ~ · ~ PH 0~ E UPVP. IPROPERTY BOOKED AT IPD ! r-!FOUND -~-'~E",,~DE:;~E --":,:~--Z::'---=~:":~ t '_J DESTRUCTION p M F [~YES ! ~_EC.ARATiCJ:.. · -' '. ,"~( j HAVE FURTHER INTEREST IN THIS PROPERTY ' ".":;E POUCE DEPARTMENT ;/.,C.-2CI2600' ' lCF Icg~2.O ,,~.~RREST M INCIDENT '\ DAT[ TIME O~ OCCURRENCE I ? DATE/TIME REPORTED TO P.D. I .L;OCATION OF OCCURRENCE l,,V-.=-~7 'z:~ ~ / 1/'~- ~.-o~, ~=z4 ~-O~-,~ ~- ,/~' /~.-~-'~"~'Y, VICTIM OR MSG PERSON'S NAME--LaSt, Fwst. ~ (FIRM IF BLI~NES~) 10 RESIDENTIAL ADDRESS '1 11 RES. PHONE ,,X--RACE 114 AGE 15 DOB 16 BUSINESS ADDRESS ($CHOO:. IF JUVENILEI ~? IqU$ PHONE X CODES FOR BOXE$ 20 & $0 V VICTIM P ,= PARENTILmaamd~u~.a,,~aeat DC = ~OVEREDC~EOFINCIDENTI~8 CHECK IF MORE NAMES ON PAGE 1AA[) W: WITNESS RP ~ REPORTING PARTY MIP ~ MISSING PERSON I 1~ NAME--L~I. Fff$1, M~aOle 2:3 OCCUPATION 124 SEX -- DOB 21 NAME-H,a~t, F~rst, I~badie 33 OCCUPATION [ 341 [;EX ,~F '3S~&GE.., 13' DOB MISSING PERSON (SEE INSTRUCTIONS} MENTAl. CONDITION 20 CODE 21 RESIDENTIAL ADDRESS 27 BUSINESS ADDRESS (SCHOOL IF JUVENILE} l.~'~,o p,~,~ P~ 131 RIE~NTI~d. ADDRESS 40 PROBABLE CAUSE OF ABSENCE 37 BU~INF, S~ AODRE'"'~ (SCHOOL IF JUVENILE) 41 22 RES. PHONE · J2~ BUS. PHONE I 38 RES. PHONE 38 BUS. PHONE I X,' 42 IDENTIFYING MARK,S~CHARA~T~RL~"TIC~ OF M/P 43 VEHICLE DRIVEN BY MIS~ING PER~ON, - [44 WHERE LOCATED ON PRIOR OCCASION JUVENILE __ARr""'TEE (SEE INSTRUCTIONS) ~;~,ADULT [~4& DATF, rrlME ARREb-i F,D 147 LOCATION OF ARREST ' 1481PKG'AREA a ' IREPT.' DIST i 4,5 OF ARRESTEE-,-Last, F~St, Mmlaie ?/_.~//%~g~/' P~.,(x'6I~ /~::V~I~I~' t_9. LOCATION BOOKED ACTION T~,,.~N/ 51 BOOKING NUMBER Is2SOC. SEC. NUMBER .. 4i DA~~u ..... 53 CHAR~(S~~ WARRANT NUMBERS. COURT. JUDGE ISSUING ENL. AND DATE ISSUED - /~,~oo,, ~ - ~r,,,.,a ~,,,.,.,,, c,.,,,~_, /,(Pg. - ~.~,~.~,..<.-/ ~,'~,~,,,-,.~- e~ H*aaC,0LOR I" EYECO~OR Is2 COMP~ 163 P[.ACE OF BIRTH $? RESg::~4TL~L ADDRESS - I ~ # [ 68 DESCRIP¥iON AND D~POSITION OF ARRESTEE'S $~ WAS aDMONITION OF CONSTITUTIONAL RIGHTS GIVEN'/ YE.,%,~- BY WHOM? DATE/TIME GIVEN MODUS OPERANDI (SEE INSTRUCTIONS) REQUIRED FOR ALL: FELONIES, SEX CRIMES, NARCOTIC CASES. 488 P.C. DESCRIBE CHARACTERISTICS OF PREMISES AND AREA WHERE C~I-~-N~E OR INCIDENT OCCURRED 71' DESCRIBE BRIEFLY HOW OFFENSE WAS COMMITTED '172 DESCRIBE WEAl=ON INSTRUMENt. TRICK. DEVICE OR FORCE USED - :73 MOTIVE -- TYPE O; PROPERTY TAKEN OR OTHER REASON FOR OFFENSE ESTIMATED LOSS VALUE AND/OR EXTENT OF INJURIES--MINOR, MAJOR · -- WHAT DID SUSPECTIS) SAY-NOTE PECUUAt:b't, ~ -- ~'S N:;TIVITY JUST PRIOR TO AND~OR DL;A;NG OFFENSE · ~-~-RADEMARK--OTHER DISTINCTIVE ACllON OF SUSPECTtS) ~ BY SUSPECT--I-K;. NO., ID No.. ¥®~r, Ma~e. I~:~tei. ~s (Other iD ~ter~ttcs) Su~ECT ~. I (~T ~STED~t. F;~. ~ ~ ~DCNU~ ADDRESS· CLOTHNG. ~D OTHER ID M~KS OR CHARACTERISTICS SUSPECT NO. 2 (NOT ~RESTED~L F~st. Mm~e ~ ~  FBI. OR DL NUMBER ADDR~. ~O~ING. ~ OTHER lO ~ OR CH~TER~TI~ ~ UNFOUND , . : . ..!~ ! i ~ I COPIE~ TO: i 1~ .~IV. *!~ O~er d. Conaum- Livestock able Gels. ~ -. DATF..,'TIM[ / z-3-,.a'2 1 PART II CRIME[ eel~ I ~1., VI-, 0..302600 · ~- ;TINUATION ~ SUPPLEMENTAL C'--C .CTION OF ORIGINAL C;'.;k'.[' ~.'~ INCID[N~ 2 ~..~!ME OR iNCIDENT \ 0 cl;riZEN STA'~EMENT RE PORTED LOSS: ~AME OF PERSON MAKING STATEMENT--4.a~t, F~rst, M~Ome ADO~ESS n RESiD. t-~ BUS. PHONE NUMBER DATF'TIME STATEMENi WR~T'~rc'.~ .~~1 LOCATION STATEMENT WRITTEN RECOVERY; ADDITIONAl. LOSS: UNFOUND LOSS: DESCRiPTIOZ ~ PROPE RT Y VALUE ~OI.K)~,,. calg~r, revolver, eic.) ' [ : : · ~ - : : i ' : i : ! ~ , ~ : .' : : : . ~ : : · i - : . . : :.' = :. 2 : : ' ' : 4 ~ ~ : : - : : : ' : : : : ~ : : : : :~ 2B ; : : ; : : : : : : 29 : . : / : 1 Cu~ency Jewelry Clothing/ Autos Office TV, Radio, Flr~s Household Consum- Livest~k Misc. PART II ~~ NED ~ T~G OFF~E R "13 27 REPORTING OFF1CER~5i [$ER. NO.I 'iNE POLICE DEPARTMIr. N i '""~ ~ Nu~aEJ~ I D^Tr-J'rI~E REPCmT 2 'INUA~ON ~ SUPPLEMENTAL X D CITIZEN STATEMENT ~AME OF PERSON MAKING STATEMENT--I~a-.t, ADDRE.~S n RESID. ~ BUS ADDRESS D RESID. ~ BUS. PHONE NUMBER ~AT=.:TIME STATEMENT WRII'rEN j 11 I,.UgAIION ~TATEMENT WRI'FrEN 1 REPORTED LO,~: RECOVERY: ' ADDITIONAl. LOSS. UNFOUND LOSS: DR NO.; t' : : ' : : : .' : .' : Currency ;./ Jewelry Prec. Metals Ce Clothing/ Furs Autos F- Office Equip. F. TV, R,.dlo, Firearms Camer&~ Ho Household Gooas L Consum- aisle Gas. Ko Misc. PART II 'CRIMES )tE$ TO: INVi D.A. ', Omer t R=~ORTING OFFICE Fi ·' J SU~ERV_I, SJ~ / ' RECEIVED DATE/rIME J PRO / )-?.-~..'-/ , / ,,') ~ ) tREPORTINGOFFICER(S! {SER NO ) .o 2eoo · I~ SUPPLEMENTAL 2 CRIME OR INCIDENT NTINU&TION ,:CTION OF OP, ICalNAL CRIME OR INCIDENT · Z_ gr~rlZEN STATEMENT , ;~ C, * .L...;ICATION T P VICTIM'S N*,AMuE--La~t, Frst, ~ (FIRM IF BUSINESS) [$8 ADDRE~ ~ RESID, L, ~U$ [ I PHONE NUMBER ADDRE~ O REStD. ~ BUS. 0 PHONE NUMBER NAME OF PERSON MAKING STATEMENT--Laat, F~'M, ~ DATE;TIME STATEMENT WRII IEN i l 1 LOCATION STATEMENT WRIT'TEr~ 2 fl~:POHTEU LOSS: RECOVERY: ADDITIONAL LOSS: UNFOUND LOSS: DR NO.: Currency Jewelry Clothing/ Autos Office TV, Radio, Firearms Household Consum- I Pre~. Melal: Fur~ Equip· Cameras Goo~s able GUs. P.S./ i LOSS) UNF. 2 ~)PtE5 TO iNV. D.A. ~ Orner " 1 ISUP£RV~SOR ~ ' SEn. NO. I RECF..'WEO i _** · Livestock Mtso, PART 11 · CRIMES