.. OFFENSE REPORT NO. I - Nogmgg I I NAME (Firm name if business) '2 AGE DESCENT SEX DOB 3 PHONE (Business) . ..- - "7 4 ADDRESS 5 CITY 6 PHONE (Residence) . g-F' 243/3 $4.4 ma/gr/t cr/G'N- /2'07 7 BUSINESS, EMPLOYMENT OR SCHOOL 8 OBJECT OF ATTACK Iadrglory. Theft, assault, etc.) 9 PLACE IIVHERIE OFFENS-E OCCURRED I0 TYPE OF BUILDING (Residence, s1ore. bank. elc.) -L II REPORTED av PHONE 12 REPORTED TO /er-w 13 DAY. DATE TIME OF OFFENSE I4 DAY. DATE AND TIME OF REPORT I5 BODILY INJURIES TO I6 HOW REPORTED (In person, phone. On view, other) I7 (How done -- force used - at what point -- wi1h whal tool or weapon - other acts or Trade marks) l7A EXACT WORDS USED BY OFFENDER I8 VEHICLE INVOLVED IN OFFENSE (Year - color - make - model - auto license no. - year - slate) Complainant's 5u5pec1's 19 DIRECTION OF FLIGHT AUTO CI FOOT 20 WILL COMPLAINANT . STREET OR ROAD Cl UNK. OTHER 21 NAME AND ADDRESS OF SUSPECTISI -- OR AGE DESCENT SEX DESCRIPTION 22 CIRCLE IF SUSPECT I5 1 Employee - Relative - Acquaintance 2 . '23 WITNESSES NAME. BEST CONTACT ADDRESS AGE BEST PHONE OTHER PHONE PARENT OR I 2 24 NARRATIVE (Write in any available details no1 covered above} 0,1; JZ7. ./F'/fem #7 /7207' Lamas' 73f c- I I 320 /(fir! 25 INVESTIGATING 96 REPORT MADE By 0. 2:3 THIS CASE I5 29 APPROVED av Yes No Cleared by arresl Unfounded Inuclive Ofher I ll:.