u TRAFFIC STOP REPORT Agency Name Date(Month/Day/Year) Time County of Stop Officer lD Number City of Stop Part I lnitial Purpose of Traffic Stop (check only one) tr tr tr ! n tr n checkpoint Driving While lmpaired lnvestigation Other Motor Vehicle Violation safe Movement Violation Seat Belt Violation tr tr tr Stop Light / Sign Violation Vehicle Equipment Violation Vehicle Regulatory Violation Speed Limit Violation Vehicle Driver lnformation Ddve/s Age _ Drive/s Race sex D Drive/s Ethnicity tr D.ivers Male Non- Hispanic fl tr tr wtrire tssueo No Action Taken n tr tr Citation tr tr Asian (Pe,son ot Mexican, Pueio Ricn, Cuban, Central or South American, ot othet Spanish CultuB) Hispanic On-View Stop (check only one) Anest ------i lf anest made, who was arrested? waming written warning verbal tr tr Driver Passenger(s) Physical Resistance Encountered Did injuries occur to the Officer(s) as a result of the stop? tr tr tr Did injuries occur to the Oriver as a result ofthe stop? I yes tr yes Oid Office(s) encounter any physical resistance from Driver and/or Passenger(s)? Did Offcer(s) engage in the use of force against the Driver and/or Passenger(s)? Did injuries occur to the Passenger(s) as a result of the stop? Yes yes Yes fl fl Euo ruo ruo ENo fl t',to Vehicle/Drive/Passenge(s) Search Was a search initiated subsequent to the trafiic stop? 'lI SBI-122 (Rev. 12109) Other Female Enforcement Action Taken as a Result of the Traffic E tr Native American Black search was initiated, complete Part ll Yes' E no Traffic Stop Report Part ll Type of Search (check only one) E Search consent tr Wanant ! Probable Cause Search lncident to Arrest Proteclive Frisk Basis for Search ! tr Erratic/SuspiciousBehavior lnformant's Tip n n tr tr Observation of Suspected Contraband Other official lnformation Suspicious Movement Witness observation Person(s)ruehicle Searched tr tr ! tr Was the Vehicle Searched? was the Driver Searched? Was a Passenger(s) Searched? Were lhe Personal Effecls of the Driver and/or Passenge(s) Searched? Yes Yes Yes Yes E Dro Ll ro r,lo !No ldentify the sex, race, and ethnicity of each passenger searched Age L Race Sex Native Male Passenger 1 Passenger 2 Passenger 3 Passenger 4 IIIIIIIIEIIIIIIIIEIIIIIIII-III-I-IIE- Female White Black American Asian Other Hispanic NonHispanic Contraband Found Contraband found as a resull ofthe orugs nlcotrot Money -Ounces Weapons -Pints -Dollar ott", -Number Property Seized -Dollar ! E ! ! D search: tr None -Pounds -callons of Weapons Amount -Oosages Personal Property [ ruone OR complete E other Property -Kilos the followinq: Office Use Only Reviewed Entered SBI-122 (Rev. 12109) -Grams Amount Property seized as a result oflhe search: E MotorVehicle ! OR complete the followinq: I L Date lnitials