ctIARLOITE-llECKLENBURG ARREST PROCESSING CENTER ARREST AfFIDAVIT

e l'Ylltl\.C. I . FIRST MIDDLE

2. WHEN 010 THIS INCIDENT OCCUR: DATE: OJ ho !rorz TIME: _'-'1)'-0...,(,"-___ _

3. WtERE 010 1liIS INCIOEKT OCCUR?

4. VICITIM NAMEJ8USlNESS-lEGAL NAME: _....:;5!...Ih~k"'--...!;cJ-!::.._AJ=.C"_. _______ _ VICTIM'S ADDRESS: ------------------ PHONE __ -__ -c ___ _

':---UluVlCnM RECEIVE MEOICALATTENnON? YES INO HOSPTIAlIZED? YES I NO

DE~iCRlIII;,,~IJRlE'S & CONOmON: _______________________________ _

8. VICTIM'S :::;~~~~~~;-~~;SI1IUNG:~8OYFIUEHO~ GIRU'RIE"" OTHERF-.VMBl8ER FREND NaGH80R EMPI.OVEE ...... OYER STIIAHGER (CofiaEOHE)

7. 00 VICTIM AND DEFENDANT LIVE EVER lIVED TOGElliER? YES I NO

8. DOES THIS INCIDENT INVOlVE DOMESTIC VIOlENCE? YES I

9. IS VICTIM WIllING TO PROSECUTE? YES I NO

10. HAS VICTIM PROSECUTED THIS DEFENDANT BEFORE? YES I NO

11 . VICTIM: SOBER? __ DRINKING? _INTOXICATED? __ DRUG IMPAIRED? __

=== 13. DID ~NDANT MAKE ANY STATEMENT TO POUCE? YES @

TO WHOM I EXPlAIN:

14. DESCRIBE PHYSICAl EVlDENCE: __ ..li.~;J!Ii:~-------------

IS. LOCATION OF EVIDENCE: POUCE PROPERTY ROOM \/'" < RETURNED TO OWNER: __ _

OTHER: ~--------------~-------------=~-----

16. ARE THERE co.OEFENDAHfS? YES/@) ARRESTED? YES/@ GIVE .NAUES: _______________________ _

lARCENYIPROPERTY OAMAGEIUNLAWFUl CONCEALMENT, TOTAl. DOUAR AMOUNT:

$ WAS RESTrTUTION MADE? YES/NO

CONTINUED ON REVERSE SIDE

"

19. CK FORGERYIFRAUD CASE (IF APPUCAIIlE) BANK NAME & LOCATION, ACCOUNT NUMBER, ACCOUNT YABLETO, DATE. AMOUNT: ____________ _

20. vetICLE lARCENYIUNLAWFUI. CONIIE't O/lARCENY FROM AUTO (citde one) VEHICLE:

YeAR STAll! MoDe. COI.oR VIM. OWNER: ~,COMPI ___________ __

21. TESTIMONY -INDICATE WHAT YOU OffICER IN CHARGEMCTlM'SlWlTNESSES CAN TESTIFY TO: ·OFFICERINCHARGENAME: ) Code# AsIIgnment'-.. ___ _

Do -\A.o.. .b,.c. 1"J,J. J...!< ".J.p..~ "'~ f-l"- I,,!.J loc<4.'Wl .£Io~ ~ \fot"..!",! c""/.....\. I.> I .J.,k .0 G1.9 "Ji., c 5 "b,l''''/' . (1,/0 .. W e". (o.,..j-

r'11\~ J:-I.. p,,4 (20.&1- I/:J fvll h .. ~''''' ",A- ," ,f'>k "-10 -It-. 'j".&.J tt. f; I, h,""'- (;,C .C/:....., :;Jc.+, . T1.. A \'ItA '" ,,~ h"J &; "":»" .f- .M. '1"- , 1L- ~ 4' *.0 (Ii.u..l ,,4 M r~'" /.0,. v9SS4»-S.vl J..- ~M0'\A.' J~. fr .. " ...... s'~ .... 'i 1<'-'''' +to.. /.. '" r'j~1- h"J.

. '

• • • • • • • • • • • • • • • • • • • • • •

THE

TO_ ......