MACON POLICE DEPARTMENT INCIDENT REPORT

CASENUIolBER

IMIII<lIII~Ia'laI3111

INCIONT LOCATION

CITY

STAn

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1. WERE CHILDRENINVOlVED? DYES

\
0 NO

2. WAS-ACTCOMMITTEDWITH CHILDREN PReSENT? 0 YES

3. NUMBeR OF PREVIOUS COMPLAINTSAS AOVlSED BY VICTIM: oD 4. EXISTENCEOF PRIOR COURT ORDERS: 0 YES

0109

0&-10 0 NO

oMORETHAN10

0 NO 0 UNKNOWN

5. WAS VICTIMADVISED OF AVAILABLEREMEDIESAND SERVICES? 0 YES

FOR THE FOUOWINQ ITEMS CHECK ALL ntAT APPLY 6. - FATALINJURY 02- PERMANENT PHYSICAlOISABIUlY 03 - TEMPORARYOISABIUTY 04 - BROKEN BONES 05 - GUNIKNIFE WOUNOS 08 - SUPERFICIAL\NJURIES 07-PROPERTYOAMAGEITHEFT De-THREATS 09-ABUSIVELANGUAGE 010-SEXUAI.AB~ On-OTHER De-NONE

me AND EXTENT OF ALLEGEDABUSS BY THE PRIMARYAGGRESSOR: 01

7. POUCEACTIONTAKEN: 01-ARREST OZ-CITATION 03-SEPARA11ON 04-MEDIATION 05-0THER IF NO ARRESTMADE. WHY NOT? 01 - JUVENile 02 - PRIMARYAGGRESSOR WAS NOT ATlHE SCENE 03 -INSUffiCIENT PROBABLECAUSE 04 - OTHER REASON(S) e. HOW WAS PRIMARYAGGRESSOR IDENTIFIED? 01 - PHYSICALEVIDENCE 9. DID INVESTIGATIONINDICATETHAT SUBSTANCEABUSEWAS INVOLVED? 0 YES 0 NO IF YES INDICATESUBSTANCE(S)USED BY PRIMARYAOGRESSOR(A)AND/OR VICTIM(V): A: 01 - DRUGS 02 - ALCOHOL v: 0 1 - DRUGS 02 - ALCOHOL

02 - TESTIMONIAl EVIDENCE 03 - OTHER

10. AELAnONSHIP OF PRIMARYAGGRESSOR TO VICTIM(S}: 01 PRESENT SPOUSE 02 - FORMER SPOUSE '03, PARENT 04- CHILD 05- STEPPARENT 06 - STEPCHIlD 07 - FOSTER PARENT 0 e - FOSTER CHILD Ot-NONE OF THE ABOVE.BUTUVES IN SAME HOUSEHOLD. EXPLAlN:

MACON POLICE DEPARTMENT SUPPLEMENTAL

I COOESTDBEUSEO: AAmmo CCILAI D-UNtDENTIDI!AOy.A/ISSINO SSUSI'CT W-wme5

REPORT

CASENO.

L4.0CATED YADOI1lONAI.~

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INAME(lAST;FlRST; ~(USE

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ALIAS

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I HRS. WORKED

BUSINESS ADDRESS

CITY STATE ZIP COOE I BUS.PHONE(WllItU code) IOFFENDER TRACI<1NO NO.

OCICQ.ASSlI'lCAnONNO. COIlE IHNoIE (LAST.FIRST, "'IODL) (USE COL. 8)

CITY STATE ZIP CODE IHOMEPHONE (WIa codel

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SOCIALSECURITY NO.

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A 1 0 zOO 3 0 4 0 0 0 B 0

DATEANDTiMEOFARREST

HOWE OF"MPLOVEROR OCCUPATION GCICa.ASSlFICATION NO. HAlflCOLOA RACE A 1~ 20 3 0 4 50 GOO SEX A 170 2 0 0 B MALI! FEMAlE 0 0 0 IIlACK WHITE HlSIWiIC OAIENW. OTHER UMCHOWN 1~~ 20 30 40 50 0 0 0 0 BlONDE BROWN GRAY GRAYING A 70 10 B 80 70 80 00 B

BUSINESS AOOIIESS

CITY STATE ZIP CODE I BUS.PHONE(wJaoa code) IOFFEHOERTRACI<INO NO.

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0

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