PERTH AMBOY POLICE DEPARTMENT
USE OF FORCE REPORT

A Inn-Hem Whrmafon

 

 

olWeek
9/3510! 30/ch

 

?1572?:

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El .13..?de In progress Dammit: l0 Othar dlsputa Suaplcloua parser: 0 Traf?c stop
Gt er 5 
Of?cer Information .
Namel t.Fl t, Middle) .h 3&de Sex Race Age anlde Kltled
?22 76% Dow/t8 33 "69 
nmanl 4 Years of Nice Orr-Duty Unh'pnn
VoiJFFo/m em Malina: 170017571? 3% @m 67;?

 

 

 

 

 

 

C1. Subject 1 (Met nnly the person who we're the subject of the use at force by the of?cer llstad In Section B.)

 

 

 

 

 

 

 

 

 

Thmatened/amed ol?cer or another with oblaot
El Threatenedlattactred officer or another with motorvehlcta

 

Nam (Last. ?rst. Sex Rana Age ngon 
ram/W rat/m A
Arms ?3 1' QC 
UGlherumsml (an ?5 QC 0W 
Sect?ulg 3 agent; (check all that apply} mega Use at tome toward subleot (meek all that apply)
Hesislm police ul?car canlrol )stompllame hold ?rearms 
Phyaleal Ma?attack on officer or another Hands/flats intentional
C3 Threatened/attacked of?cer or anotharw?h blunt ubiect cha?aat {3 Accidental

KChemloaUnatum! agent

Strikefuse baton or other obleat Numberol Shots Flrad

 

 

 

 

 

 

 

 

 

 

 

 

Threatened of?cer or another with 11mm El Carina Number ol 
Fired an of?cer or another {Use it unknown]
.mnmm Other (899le
C2. Subject 2 (List only tha person who was the subject of the usa ol lame by (ha of?cer llaled In Section B.)
a (Last. First. Sex Race Age Weapon lnlunad tull?id
I -
El Underme In?uence Arrested Charges
Other unusual (specify) a. 
Sugect's 393133; (check alt that apply) mm use 1% toward this suhlg (check all that apply)
Cl Restated police ottlnar comm] Firearms 
Cl tlwaatiattack on ef?uent-another . Cl Intentional
Emacs/tear Cl 

Tmaatenedfattadred ottlcer or another with blunt 0121th

El Threatened/attacked of?car or another with knlle/cm?ng object
Threatened/attacked ot?car or another with motor vehlcle

Threatened ot?cer or ?rearm

- El Fired at of?cer oranother

 

   
 

Cl agent
Cl Strikelusa baton or other object
I: Canlne

 

Nu bar IShols 

[Use if un wnl\

 

Cl Other (awn)

 

 

.D Otng?smw 

of?cer used farce agalnst more than twa subjects In this attach USE OF FORCE REPORTS.

 

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Slgnatu 

X670

 

#0222

2

 

Pdnt??pewisor Name:
5&5 

 

 





 

 

*7/2001

 

 

PERTH AMBOY POLICE DEPARTMENT

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

USE OF FORCE REPORT

A. Information 
Date Time Day otWoeit Lomtim NUMBER
await? 3435i Wit/@5947 Log 57767?? 5:7: I Bongo I 

of! am
12] Crime in progress t2] Darnestm CI Other dispute Suspicious person 0 Traf?c stop
Wherispeciivi
B. Officer information .
Name (Last. First, Middle) Badges Sex Race Age injirred Killed

$757231, Lad" I 05 35 Yl??
?ank Duty assignment Years at service Ora-Duty Uniform
037/6675 794w?!) 

 

 

C1. amSubIeot 1 (List only the person who wa's the subject at the use of force by the officer listed in Section B.)

 

 

 

 

 

 

 

 

 

Ci Threetened?attaoked ot?cor or another with blunt object
:3 Threatenedlattaotted otftcer or another with knito?mnting object
Threatened/attacked officer or another with motor vehicle

 

 

First, Middle) Sex Race Age ??8th
- 
comet/vol Pom?! ii/tmoN at? . 

t3 Under in?uence Armat? Charge
UOtiterunusuaiconditioMapeo?y) (953' ?ange/2?? 696
Songs amp. (check all that apply} use at tome towmd (M all that apply) 

Hesisled pdioe otticer control Comptlance hotd Firearms Discharge

Physioel tweet/attack on officer or another Handsl?sts El intentional

Kicks/toot Ci Accidental

Ct Chemical/natural agent

StrtitGILtse baton or other object Numberoi Shots Fired

 

 

 

 

 

 

 

 

 

 

 

 

 

[It Threatened o?icer or another with firearm Ci Canine Nomber of Hits 
Fired at or another [Use ti unknown]
rm! 0 Qh?m?i
C2. Subject 2 (List only the person who Was the subject of the use at tome by the oilioer listed in Seotion 
Name (Last. First. Middle) eex Race Age Weapon injured tuTed
YIN /Ylj~_i/ I -
Under the in?uence Aneeted 
1:21 Other unusual condition (opacity) a, .. 
I
Subject?s actions (check all that apply) ?t?at?s use at rm 1mm this sublgt (meet an that appty)
Ci assisted police o?toeroontrot Ct Compliance hold Firearms Discharge
C1 Physical Warlock on oitioor Ci Hends?iets . CJ intentional
- t3 Threatened'atteolted oittoor or another noojeot EJJGotrsiteet Ct Accidental

CJ Threatenet?'atlacited of?cer

(Either rwitit Mite/cloths; object
0 Threatenedia?aokedr?oe: mart-?n motor vehicle

 

t3 threatenodo ?rearm Ci Canine Number of Hits
- {It Fired at oranother {Use ifunitnownj
.13 1 c1 Othedswiv)

Ct Chemical/natural agent

[3 Strtitor'use baton orotiter object Number of Shots Fired

 

 

 

 

if this of?cer used force against more than two subjects in this incident, attach additional USE OF FORCE REPORTS.

 

 

 

 

 

 


Signature: I Date:
. #6/73/ aft/of/ 
tint 3:15:8me . Su mm?
?r 
775 

 

 

7/2001

 

PERTH AMBOY POLICE DEPARTMENT

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

USE OF FORCE REPORT

A. mafia-Ht lhpformation .-.

Data - Time Day of Week Location INCIDENT 

[31% WSW Tiicesont? 18K 80976 37 (304800

Tm oi incident

Gig?me in progress Domatlo Other dispute [2t Suspicious person Cl Traf?c stop
her 5 
B. Of?cer information

Name (Last. First, Middle) Badge 3 59:: Race Age inliirod 

DMZ (IE, MHKWO 4231 Yr? w?
Duty assignment Years of service Uri-Duly Uniform
?773 @m .

31. Subject 1 (List only the person who woo the subject of the use of force by tho oiiloar listed in Section 8.)

Name (Last First, Middle) Sex Rana Ago Weapon intu CT Killed

mom; gum/mm 25? 65?: mo

Cl Underthe influence Armstad Charges

23 33 2,2029 O-ZC 29

Su?s amt: (check ail that apply) oi torso towerd this subtext (check all that appty)

stated police otflcar control Pliahoo hold Firearms Discharge
Phyalwl tiuoatlattack on oitioeror another 0 Handsl?ots Cl intentional
Ci Kicks/feet mom:

0 Threatened/attacked otiioer or another with blunt obieot -
I3 Threatenoctfattactted otftcor or another with kniieldutting obieot
Threatened/attacked officer or another with motor vehicle

 

El Chemicallnatuml agent

Ci Shim/use baton or other obloot - Number of Shots Fired

2) 2039;?

 

 

 

 

 

 

 

 

 

 

 

 

 

Threatened oftioer or another with ?rearm ?3 Carina Number oi Hits 
El Fined at otticer or another it unknown)
.W1 :3 wagging)
C2. Subject 2 (List only the person who was the subject of the use at force by the ol?oar listed in Section 8.)
Name (hast. First. Middle) Sex Race Age Weapon initiiod 
I I I -
Undertho in?uence Amino Charges
Other unusual condition (specify) pk YIN 
?ngecrs actions (check all that appiy) ma gt tome toward this mtg-Mock that appiy)
Cl Resisied police ottioor central E3 Gompl hold! Firearms Discharge
Wattaok on otiloer or another It? . Cl Intentional
c1 Titnaatenodfattacked of?oor or mimWiar?? welcome: :3 Accidental
Ci Threatened/attacked of?cer or amt e/outting object i3 Chemical/natural agent
0 Threatened/attacked amthortitm motorvohicle Er Strikeiusa baton or other obtect Number or Shots Fired
Thy?edo or another with firearm E1 Canim Numborot Hits
. Fired at of?cer oranothor [Use it unknown}
ill?WI OWN)

 

 

 

 

 

if this officer us9y<??o against more than Mr: subjects in this incident. attach additional USE OF FORCE REPORTS.

 

iW?i 9?33 

Date:
530/3

 

Print Supervisor Name:

i- 312:4:an .5 MA

 

 

 

222% 

 

7/2001

 

 

Main Form Page 1 0f 3

 

 

 

 

 

 

PERTH AMBOY POLICE DEPT

PERTH AMBOY, NJ

INCIDENT REPORT OFFICER RANK REVIEW STATUS
13048011 /1 PATROLMAN APPROVED

 

INCIOENT 129130118011 DATA
As Of 12/11/2013 13:15:30

BASIC INFORMATION
CASE TITLE LOCATION 
STATE OF NEW JERSEY 183 STATE ST
REPORTED OCCURRED
09/05/2013 19:39:31 On or about 09/05/2013 19:39

. INCIDENT 
COND LANGUAGE 20:33-2

JUSTICE 20:29 -1
ARREST 20:29-2
UNLAWFUL POSSESSION 

 

 

 

PERSONS
ROLE NAME SEX RACE AGE DOB PHONE
VICTIM STATE OF NEW JERSEY, (HOME)
ADDRESS: (CELL)
OFFENDERS
STATUS NAME SEX RACE AGE DOB PHONE
DEFENDANT RODRIGUEZ, EDWIN RAMON MALE WHITE 28 01/12/1985 (HOME)
ADDRESS: 188 STATE ST. PERTH AMBOY, NJ (CELL)
0 VEHICLES 
PROPERTY
CLASS DESCRIPTION MAKE MODEL SERIAL VALUE

 

 

OTHER KITCHEN KNIFE WITH 7 INCH BLADE

 

(EFFTCER 1304,8011 1 (60}

OF REPORT TYPE OF REPORT REVIEW STATUS
09/06/2013 01:24:45 INCIDENT APPROVED

9/17/2018

 

2 Main Form Page 2 of 3

NARRATIVE

. On 09/05/2013 at 19:39 Hrs. I was dispatched to the area of State St. and
Dillon Ln. on a report of mini riding on the road swerving in
and out of traffic causing a disturbance to the surrounding neighbors.

While in route to State St. through Dillon Ln, a concerned citizen who
wished to remain anonymous ?agged me down and advised me that the
individual who was standing across the street at 188 State St. was part of the
disorderly group who were driving a pocket bike (Mini and a
large remote control car in and out of traffic.

I then crossed the street during which time while approaching the unknown
individual I observed him begin to walk away from the sidewalk towards the
residence at 188 State St. carrying what appeared to be a large gas powered
radio controlled car. I then stopped the unknown individual and requested
to see some identification in order to ascertain who I was speaking with to
which same stated he did not have any I.D. on his person. I then inquired to

the still unknown individual as to his name to which he replied "Why? I'm
on my property I'm not doing anything don't have to tell you nothing 

and again continued to walk away onto his front porch.

Upon further speaking with the unknown individual, he stated he had an
1D. in his apartment at which point I asked him to retrieve it while we both
were standing in the front lobby doorway of 188 State St.. Same attempted
to close the front door on me but was unable to, due to me standing in the

doorway. I advised him I would wait in the doorway while he retrieved his
identification at which point the unknown individual became very
boisterous, screaming and yelling in a loud manner "I'm on my property, I
don't have to give you anything" . Same then went into the hallway yelling

for his neighbors to come out and ?lm at which point approximately 6
individuals came out into the hallway along with the unknown individual
now holding a phone in his hand. I again advised the unknown individual
to retrieve his ID for me and same continued being disorderly at which
point he turned to walk up the steps stating something to the effect of I'm

not giving you shit and turned to walk away up the steps to his apartment. I
then advised the individual that he was now under arrest for Disorderly

Conduct at which point I observed while the individual was turning up the
steps that he had a large kitchen knife cupped in his left hand against his
forearm.

I then sensing fear for my own safety due to the close proximity of the
suspect with the knife in his hand and degree in which I was outnumbered,

http://192. 9/17/2018

 

2/

Main Form Page 3 of 3

I grabbed the suspect by the right wrist and ferociously took him down the
ground. While pinning the suspect on the ground I ordered the crowed of
approximately 6 individuals to maintain their distance at which point P0
L.Perez and PO M.Diaz shortly thereafter arrived on scene and assisted in
keeping the crowd back. The suspect had both of his arms underneath his
body in order to prevent me from handcuffing him and after advising him

numerous times to stop resisting at which time I used mechanical force in

the form of OC spray to get the suspect to comply, at which point he did.
The suspects' father upon request of the suspect then furnished the suspects
wallet and was identified as Edwin R.Rodriguez D.O.B 01/ 12/ 1985 . The
suspect then was taken into custody in vehicle 822. Mr.Rodriguez had
complained of pain in his right shoulder while in route to HQ Central was

- notified to dispatch EMS to booking to evaluate the Defendant's medical

condition. EMS determined Mr.Rodriguez needed further treatment at a
medical facility and was escorted to RBMC. At the Hospital, Mr.Rodriguez
was discovered to have a Fractured Clavicle to which he received treatment
and was released by Dr.Xavier. Defendant was then transported back to HQ 

in vehicle 822 for processing.

Officer's Notes: Edwin R.Rodriguez was charged with 

(DISORDERLY CONDUCT), 
(RESISTING ARREST) and placed on Summons# S2013001099 bail set at
R.O.R.

. Edwin R.Rodriguez was charged with POSSESSION
. OF A WEAPON) and placed on Warrant# W2013001098 bail set at $15,000 3

w/ no 10% option by Honorably Judge Maria Del Valle?Koch. Use of Force
report completed and submitted.

- Evidence(Knife) was logged and placed into Perth Amboy Property room
- locker 

During booking Mr.Rodriguez was discovered to be wearing a N.J. Parole
Monitoring ankle bracelet. N.J. Parole Board was contacted and advised

REPORT OFFICERS
Reporting Of?cer: 60
Reviewing Of?cer: 190

Approving Officer: GUZMAN, LUIS 184

12. sp?agency=PE. .. 9/ 1 7/201 8

 

3 Main Form Page 1 of 4

PERTH AMBOY POLICE DEPT
PERTH AMBOY, NJ

Booking Report 

 

 

3  ADULT [1 JUVENILE

Booking Information

Agency. Boo-king Number Date Of Booking I I I Date of Arrest Review Status
PER-PD TPER000021620 09/05/2013 20:07:55 09/05/2013 19:39:31 APPROVED
Event Type File PCF ID Source MNI 
ARREST 13048011 OTHER 500006007
aerate information Locai 

Name

EDWIN RAMON RODRIGUEZ
Address

188 STATE ST.

PERTH AMBOY NJ 08861

DOB Age
01/12/1985 28
Sociai Sec Gender


 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

a rg es Booking .- TPER000021620

 

Charge a 
Charge Code Charge Desc Counts

8632 DISORDERLY CONDUCT 1
Dt Charged Charge Notes

09/05/2013 22:40:24
Charge/$2 .. .. .. . .
Charge Code Charge Desc Counts
2647 OBSTRUCTING JUSTICE -1 1
Dt Charged Charge Notes

09/05/2013 22:40:59
ChargeCharge Code Charge Desc Counts
2645 RESISTING ARREST 1
Dt Charged Charge Notes

09/05/2013 22:41:17
Charoew . . ..
Charge Code Charge Desc Counts
1511 WEAPON UNLAWFUL POSSESSION 2Cz39-5 1
Dt Charged Charge Notes

09/05/2013 22:42:48 KNIFE WITH 7 INCH BLADE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

http://192. 168. 12. sp?agency:PE. .. 9/24/201 8

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

3 Main Form Page 2 of 4
a i! Booking .- TPER000821620
Bet! 

Amount Baii Set By Date Bail Set

815000.00 JUDGE DEL VALLE KOCH 09/06/2013 01:00:00

Bail Terms

FULL NO 10%

Paid By Self Bail Payor (if Not Self) Date. Bail Paid



Eve I11: I f0 at] Booking 
@931 '?f?i?ma?m ,1 

Custody Date Street Street Name Unit

09/05/2013 19:39:31 183 STATE ST

City State Zipcode Cross Street

PERTH AMBOY NJ

Municipality Business Name Business Phone

PERTH AMBOY

Fin 9 ri Booking TPER000021620
Finger Rrinte

SID FBI Prints Taken? Print 

581766C 304883PB7 22791

Print Of?cer Date/Time Taken State Prob Nam

(60) SALAZARDAVIS 09/05/2013 23:28:00
Authorization Booking TPER000021620
Authorization

Booking Of?cer Signature Date/Time Entered

60 09/05/2013 20:07:55
Reviewed By Signature Date/Time Reviewed

190 09/08/2013 03:15:22
Approved By Signature Date/Time Approved

184 GUZMAN, LUIS 09/09/2013 16:23:cteri stics Booking TPER000021620
personaipete Characterietice 7 ?7 7 77

Home Phone Work Phone Phone

Race Ethnicity Residency

WHITE HISPANIC ORIGIN RESIDENT

 

 

 

 

9/24/2018

 

 

 

 

 

 

 

Main Form Page 3 of 4
Height Weight Build
601 240 HEAVY
Hair Color Color Complexion
BROWN BROWN LIGHT BROWN
Marital Status Spouse Maiden Name
UNMARRIED
Mother Mothers Maiden Name Father
BELKIS RODRIGUES RODRIGUEZ RAMON RODRIGUEZ
Birth City Birth State Birth Country Citizen
BROOKLYN NY UNITED STATES 
License Class State Expiration Date
NJ 201 6-08-?3 1

 

 

 

 

 

Scars Marks and Tattoos

LEFT REAR UPPER ARM TATTOO LEFT ELBOW FPC:

 

 


Occupation Employer Employer Phone
LABORER GERDAU AMERISTEEL

 

 

Employer Address

 

225 ELM STREET PERTH AMBOY NJ 08861

 

 

Medical Information

Booking TPER000021620

 

 

 

 

 

 

Medical . 
Physician Treatment Location

MD XAVIER RBMC

Narrative I .. .. .. .
Fractured Clavicle Seen and released by MD Xavier.

 

 

 

 

 

StOd Booking .- TPER000021620
Suetody

Status Location

IN PROGRESS HOLDING AREA

Status Date Status Updated By

09/05/2013 20:07:55

(60) 

 

 

Notes Regarding Custody

 

 

 

 

Quetody'

Status Location

IN PROGRESS HOLDING AREA

Status Date Status Updated By
09/05/2013 22:53:09 (60) 

 

Notes Regarding Custody

PROCESSING.

ARRESTED, HANDCUFFED SEARCHED AND TRANSPORTED TO HQ FOR

 

 



 

9/24/2018

 

3 Main Form

(lustociy

Page 4 of 4

 

Status
IN CELL

Location

CELL 10

 

Status Date
09/05/2013 23:29:39

Status Updated By

 

(60) SALAZARDAVIS

 

Notes Regarding Custody

PROCESSING.

ARRESTED, HANDCUFF ED SEARCHED AND TRANSPORTED TO HQ FOR

 

Custody 

 

Status
POSTED BAIL

Location

RELEASED

 

Status Date
09/06/2013 02:21 :05

 

Status Updated By

(23) 

 

Notes Regarding Custody

 

PROCESSING.

ARRESTED, HANDCUF FED SEARCHED AND TRANSPORTED TO HQ FOR

 

 

Officer Roles

Booking TPER000021620

 

 

 

 

 

 

 

 

Officers

Of?cer RoEe

I84 GUZMAN, LUIS APPROVING
60 ARRESTING
60 SALAZARDAVIS BOOKING
60 PRINTING
I90 REVIEWING

 

 

http:// QED/policepartner/ common] crimeweb/booking/main. sp?agency:PE. ..

9/24/2018

 

PERTH AMBOY POLECE DEPARTMENT

 

 

 

 

 

USE OF FORCE REPORT.
A. Err-E?brma?on 
0ng . ITrma Day 01 Week Imang . Irymnam 4 i, 7
1'31? ?b?r 309 11/ 
ng of 
Cl Crime ?In Viagra; (3 Dana?: gm 0 om dispula Suspicious person Tm?ic 5109 I
?(swam A 

8. Of?cer Information

 

[Badges 57 {33:7 [Ram Imnaga)

 

Name (1.23.:ng Middle) 
PUMHEA xC/?e? 0/5" by??

Rank ., Year: arsengica tin-Duty UniIorm

?zz/ta: d??r?l PA?Wr??zj/ Imam/67mm: I I 

 

 

 

 

 

 

  
  

C1. Subiect 1 (Us! oniy lhe person was ihe subject of the use of force by the 'ol?f'mar Jisied In Section 
IN (Last, First, Middia) Sax {Rana I Age ?30? I InjunaJ 7
. a a, .
bili?br?r 3. le'O/V/ a; 
yr the in?uenza . Arrested Charges 
Other unusual condhfon (specify) 133,53 .

. Suy?s action: (ehwk an aha: apply) . Of?csr?s use bi force 1am: ms sub (m an thai appM
ta?Rastred pom d?carconlml . r3 Cornp?apca Firearms Discharga
Vii/Physical max/mm on of?cer or 211th Handms Mman?onal
Cl matenedfa?adred of?cer or anoihar with burnt object CJ Audda?al

Tbmmenedfa?adred of?cer or another with kn?alwt?ng obiem Cbethmiurai agent . 15
a Thraaianed'a?aaked of?cer or another with motorvehlde Strike/use baton or amerobfect Number 0! Shots Fired 
Carina Numbers! Hits Lia};

[Use if unknaunl

Firadaiof?ceroranozher
Other 5 BMW)

 

 

 

 

 

 

 

 

C2. Subject 2 (Usl only the person who alias lha subjeci of Iha use of [area by the o?jqer listed in Section B.)
Name (1.3.1. Hm. Mch?e) Sex Race Age Weapon irIIUrad KiliYIN 
Under?m In?uence Arrested Charges
Other unusual condition (specify) . I YIN I 
Su?ect?s actions (wear; an that appry) Of?cer's use 01' 1mm 1mm this sable: (check all ma: appey}
Cl Basia-led paths d?cer conlml Gunp?ame hoid Firearms Discharge 
Prmiml thwart/muck on ot?cerorana?ar Har?sz'?m, mammal
C1 MalaHdIattadred af?carcr armhervmh brunt objeci ulcers/{em CI Malaria]
Thraatened/a?aded of?caror amtharwith kn?e/cm?ng obfeal CherninL/naturai agent
0 ?re-armedfmtaaked of?carcr armharnim momrvahicia SMkeJuse baion or other object Number of Shots ?red 
hummer-red of?cer or amlharw??h ?rearm C1 Cam Number of HRS
Fired at of?cer Crammer - [Use if unknown}
Other (spasm am

of?cer Used force against more than two subjecis in this incident. a?ach additional USE OF FORCE REPORTS.

7974-? Mme/M raw/Egg; I
Wig/rim; 00/777740 Wg I
7/2001

 

 

PERTH AMBOY POLICE DEPARTMENT

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

  
   

 

 

 

 

 

 

 

 

 

 

    
  
  
    
  

 

 

    

USE OF FORCE REPORT
A. matte?zit tn?formatton
Data 1 Ttrna Day of Week I Location mama614% team uC?th?Am 1% Ham tarot: 
Tm of Incident 
Crime In progras Jae-Ito :3 Other dkpute Ct person Ct Traf?c stop
or {Specrtv' 
B. Of?cer Information 
[Name (Lat First, Middle) [Badge [Sax Raca Age KJttad
. . - 
amta . 67; na 0337 tr a) 5L0 
Rant: Duty assignment Years of service . On?Dury/ Unttarm
P'Qs?g Wz? Eom IS?mant?frs G7 
01. Subject 1 (List only the person who was the subject of the use of force by the of?cer Hated in Section B.)
Ema (last, First, Middle) [Sax ?Raca Ago Eli-gm tntunad retract
. Exxon a .
Underthe tnttuatne Arrested Charges 
?133) . YIN 7?7/29 
Subt?s actions {check at! that a'ppty) Ott?tcer?s use at tor-ca award this 511th (check all that appty]
{a Restated pdtce ot?caroontrot :2 Compliance hold Firearms 
ti Phyatmt on of?cer or another Harxda??sts Wen?mat
Ct 't'hraatenod/amoked of?cer or another with object Ktcka?aet {It Amtdentat
Threatened/attacked ot?cer or another with anatcanung object Chantal/natural agent . . .
t3 Threatmot?attaoked of?cer or another with motor vehtote Ct Strike/use baton or other obiect Number ot Shots Fired gilt.?
Threatened of?cer or another with ?rearm Carina Number of i git: 1K.
Fired at oranottjtar . (Ursa it unknown]
Other 5 to? Mom): .i awards 0.3 4 who. . a 01th
*{oxv rBtm. -
C2. Subject 2 (List only the person who Was the subject of the use of torso by the of?cer ttsted tn Section 8.)
Name (Last. First, Middle) Sax Race Ago Weapon tnturad 
I -
Ct Underthe tnttuenoo Matted Charges
Other unasuat oondt?on (spem?y? YIN 
Subjects acttons (attack at that Of?cer?s tsa of 1m toward this (chad: art that appty}
t3 Restated potter: ot?oar oontmt Ct hotd Firearms Discharge 
HMS/?sts. Ct Intonttonat .
Ct Threatonodfattaokod of?cer or another with blunt object Et,t0d<srteet Ct Auidantat
t3 Threatened?at'tacked of?cer or object Ct Chant-atlnaturat agent
CJ threatened/attacked amth-arm?th motor Vehicle Ct Satke/use baton or other object NUmber or Shots Ftred
Threatened of?cer or ?rearm Ct Cantne Number of Hit:
It] Fired at of?cer oranother [Use tt unto-tom]
Other 5 Ct Othe?soadm

 

of?cer used force against more than hm: subjects in this incident. attach USE OF FORCE REPORTS.

ago (96 . Mm 

Print em'sorNama: . Su 'sorSt I .l 
14le mom

 

 

 

 

5 Main Form

 

PERTH AMBOY, NJ

 

INCIDENT REPORT 
13064604 1

 

 

 

9.1m:
RIVERA, ARCADIO

Page 1 0f 2

PERTH AMBOY POLICE DEPT

RANK
PATROLMAN


APPROVED

 

#:3064602; DATA
AS Of 12/17/2013 17:25:56

BASIC INFORMATION

CASE TITLE LOCATION UNIT 
STATE OF NEW JERSEY 195 HALL AVE
REPORTED OCCURRED
12/04/2013 13:18:27 On or after 12/04/2013 13:15
3 INCIDENT If 
AGGRAVATE KNIFE 20212-1
3 THE JOB INJURY NONE
.3 PERSONS
ROLE NAME SEX RACE AGE DOB PHONE
.: INJURED PUNTIEL, P.O. RAFAEL MALE WHITE 43 07/03/1970 (HOME) 732-442-4400 
PERSON ADDRESS: 365 NEW BRUNSWICK AVE. PERTH AMBOY, NJ (CELL)
- INJURED FONTAN, P.O. GINA FEMALE WHITE 36 10/20/1977 (WORK) 732-442-4400
PERSON ADDRESS: 365 NEW BRUNSWICK AVE PERTH AMBOY, NJ (CELL)
VICTIM STATE OF NEW JERSEY, (WORK) 73 2-442,4400 
ADDRESS: 365 NEW BRUNSWICK AVENUE PERTH AMBOY, (CELL)
NJ
REPORTING RIVERA, P.O. ARCADIC (WORK) 732-442-4400
PERSON ADDRESS: 365 NEW BRUNSWICK AVENUE PERTH AMBOY, (CELL)
NJ
OFFENDERS
. STATUS NAME RACE DOB gm
SUSPECT RODRIGUEZ, DIXON MALE WHITE 32 01/17/1981 (HOME) UNK
ADDRESS: :95 HALL AVE 3 PERTH AMBOY, NJ (CELL) UNK
[No VEHICLES 




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nnroirr: 1306.51.694. 1 ARCABEG (3.2.)

 

OF REPORT TYPE OF REPORT REVIEW STATUS
12/04/2013 17:26:18 INCIDENT APPROVED
NARRATIVE

On 12/04/2013, at 1318 hours, P.O. R. Puntiel and PO. G. Fontan were

dispatched to 195 Hall Avenue on a request Officer call.

P.O. R. Puntiel then transmitted over the air "Shots ?red, send medics." All

available units responded and the scene was secured.
Both Of?cers were transported to Raritan Bay Medical Center.

There was a body of an unidentified Hispanic male lying on his backon the

street in the area of 195 Hall Avenue. Same was bleeding from the head
area as a result to a serious head injury.

The unidentified male appeared to be unresponsive. Medics then arrived at

the scene and attended to the unresponsive male. Medics then made the
pronouncement.

I was then assigned by the Street Sergeant to start a Crime Scene Log.

5 The Middlesex County Prosecutor's Office was notified and responded. I

was then replaced by one of the County's Investigators and I turned over the
Crime Scene Log. 

1. REPORT OFFICERS

Reporting Of?cer: RIVERA, ARCADIO 32
Reviewing Of?cer: KENNY, KEVIN 222

Approving Officer: GUZMAN, LUIS 184

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PERTH AMBOY POLICE DEPT

PERTH AMBOY, NJ

INCIDENT REPORT OFFICER RANK REVIEW STATUS
13064604 2 SERGEANT APPROVED

 

#1300413104 DATE
AS Of 12/17/2013 17:25:56

 

BASIC INFORMATION

CASE TITLE LOCATION 
STATE OF NEW JERSEY 195 HALL AVE

REPORTED DATE OCCURRED

12/04/2013 13:18:27 On or after 12/04/2013 13:15

INCIDENT TYPE OFFENSE 

AGGRAVATE KNIFE 20:12-1

. THE JOB INJURY NONE

PERSONS
ROLE NAME SEX RACE AGE DOB PHONE
INJURED PUNTIEL, P.O. RAFAEL MALE WHITE 43 07/03/1970 (HOME) 732?442-4400
PERSON ADDRESS: 365 NEW BRUNSWICK AVE. PERTH AMBOY, NJ (CELL) 
INJURED FONTAN, P.O. GINAM FEMALE WHITE 36 10/20/1977 (WORK) 732-442-4400 
PERSON . ADDRESS: 365 NEW BRUNSWICKAVE PERTH AMBOY, NJ (CELL)
VICTIM STATE OF NEW JERSEY, (WORK) 732-442-4400
ADDRESS: 365 NEW BRUNSWICK AVENUE PERTH AMBOY, (CELL)
NJ
REPORTING RIVERA, P.O. ARCADIO (WORK) 732?442-4400
PERSON ADDRESS: 365 NEW BRUNSWICK AVENUE PERTH AMBOY, (CELL)
NJ
OFFENDERS
- STATUS NAME RACE ARE DOB BLIQILE
SUSPECT RODRIGUEZ, DIXON MALE WHITE 32 01/17/1981 (HOME) UNK

ADDRESS: 195 HALL AVE 3 PERTH AMBOY, NJ (CELL) UNK

VEHICLES 
NO 

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OFEEQER REPORT: 3.306%604. - 3 H?RRigj??Ui?if? (12:23:.

 

OF REPORT TYPE OF REPORT STATUS
12/04/2013 18:32:58 SUPPLEMENT APPROVED
NARRATIVE

On 12/ 04/ 2013 at approximately 13:20 hrs. myself and Det.Kelleher
responded to the area of 195 Hall Ave on a report of an officer involved
shooting with PD. G.Fontan and PO. R.Puntiel. Upon our arrival we spoke
with Sgt.Pardo 8: Capt. Cattano who advised us of the situation. Photos were .
taken of the scene,but a short time later the Prosecutor's Office assumed the 
scene. The entire scene was processed by the Prosecutor's Office including
the collection of all evidence.

Photos placed into the ID Bureau's Master Photo CD file.

3 Copies of the scene photos were given to Det.R.Estrada in the Office of
Professional Standards and the Prosecutor's Office by Det.Kelleher.

I See P.O. A.Rivera's report for further information on this incident.

REPORT OFFICERS

Reporting Of?cer: 122

Reviewing Officer:

I Approving Officer: TERRANOVA, PHILIP 82

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Main Form Page 1 0f 2
PERTH AMBOY POLICE DEPT
PERTH AMBOY, NJ
INCIDENT REPORT OFFICER RANK REVIEW STATUS
13064604 /3 SERGEANT APPROVED
DATE
As Of12/17/2013 17:25:56
BASIC INFORMATION
CASE TITLE LOCATION 
STATE OF NEW JERSEY 195 HALL AVE
REPORTED OCCURRED
12/04/2013 13:18:27 On or after 12/04/2013 13:15
INCIDENT 
AGGRAVATE KNIFE 
THE JOB INJURY NONE
PERSONS
ROLE NAME SEX RACE AGE DOB PHONE
INJURED PUNTIEL, P.O. RAFAEL MALE WHITE 43 07/03/1970 (HOME) 732?442m4400
PERSON ADDRESS: 365 NEW BRUNSWICK AVE. PERTH AMBOY, NJ (CELL) 
INJURED FONTAN, P.O. GINA FEMALE WHITE 36 10/20/1977 (WORK) 732-442?4400
PERSON ADDRESS: 365 NEW BRUNSWICK AVE PERTH AMBOY, NJ (CELL)
VICTIM STATE OF NEW JERSEY, (WORK) 732-442?4400 
ADDRESS: 365 NEW BRUNSWICK AVENUE PERTH AMBOY, (CELL)
NJ
REPORTING RIVERA, P.O. ARCADIO (WORK) 732~442n4400
PERSON ADDRESS: 365 NEW BRUNSWICK AVENUE PERTH AMBOY, (CELL)
NJ
OFFENDERS
STATUS NAME SEX RACE AGE DOB PHONE
SUSPECT RODRIGUEZ, DIXON MALE WHITE 32 01/17/1981 (HOME) UNK
ADDRESS: 195 HALL AVE 3 PERTH AMBOY, NJ (CELL) UNK
VEHICLES 1


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3.3064604 2 

 

OF REPORT TYPE OF REPORT REVIEW STATUS
12/04/2013 17:30:58 SUPPLEMENT APPROVED
NARRATIVE

P.O. R. Puntiel was hospitalized for observation following an Of?cer
involved shooting.

P.O. G. ontan was hospitalized for observation following an Of?cer
involved shooting. P.O. G. Fontan also suffered complaint of pain to the left 3

. side of her head (behind her ear) and complaint of pain to both her knees

and her right elbow.

Both Of?cer's were treated at Raritan Bay Medical Center and released

REPORT OFFICERS

Reporting Of?cer: 21
2 Reviewing Of?cer: KENNY, KEVIN 222

I Approving Officer: GUZMAN, LUIS 184

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