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7 <br /> EVERETT POLICE DEPARTMENT STATEMENT FORM <br /> CASE# DD ( 3 - toAR:3 <br /> z ��I (�a2�u2 2 <br /> STATEMENT OF: g 142-- <br /> /��J� �y LAST NAME 5�n1/ 5y{� FIRST NAME MIDDLE NAME �'f} <br /> �e <br /> RACE SEX rSEX ' DATE OF BIRTH HEIGHT / ��HT PA-7 eEYE COLOR HAIR COLOR <br /> 15 — J Da+h ' - Sty e 03 EJece. u9 020 <br /> RESIDENCE:7STREET ADDRESS CITY ST ZIP <br /> HOME PHONE :�V /3 S- <br /> WOR 4e•: 11a5�3�/,,lI EMPLOYMENT: <br /> PaCe 04 <br /> ALTERNATE CONTACT(IN CASE OF RELOCATION): (\(1Q I' rN 1<oDI\C_k_c_ -T t*' /qq l 'O_- <br /> O n Gcl2 y M k rt iN`Yik_ os-( t to VfL__fl 1 z-ox 07'3 d r m-3pivu, <br /> h -'--6.-F h(5 J�1,-\‘2 MoD t2 o r? ,.d 14- 1 0 0a <br /> \ n u, G- v -f <br /> 6- <br /> ‘ _Q- uss pA s �.cV-x ► \1 e_a(d, 2S sL` <br /> P � <br /> sa SOcc\ e Ir. k nau.> u off'" \ \A 2\ ,e.AeA E cQs <br /> P <br /> _t_. /im <br /> cc-i-A--- ck+ \ kms , - vilri • <br /> 5 ,\,- k.k., -4).. (e_ a qe-ca- r . )eiiLe,)-A-A- PGfe_R-KP_& c,,,1 esn)2-'46 <br /> onto. ay _ uou- ti, 1g_ <br /> Rays h N� a m �u I\, ir:_. \--Nb\tAAT a c-.6_,\__--i , 0 --(-- <br /> U-)0TA � � ace-g_p e6 t 1 ) l Z fit- --- ,r ea ms a ( sa <br /> tiY�I -kal�a�- 'u-e_ w t.42es,:al_ <br /> ece,0IA9( aN. c=.--C- \5 -V-,(4-1 , Z tip t a..0A2 cFPSG-A-I <br /> 1 n p\ci �" Nu V lkcacknk or ` -� s Ina. t-, �-L �.(I's, Qi\ ,s u c-v- ,S c, I�. b I �_ 0, , <br /> wO <br /> THIS STATEMENT WAS WRITTEN ON MY BEHALF BY: <br /> I DECLARE UNDER THE PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE <br /> FOREGOING WRITTEN STATEMENT, CONSISTING OF 1 PAGES, IS TRUTHFUL AND ACCURATE TO THE <br /> BEST OF MY PERSONAL KNOWLEDGE. EACH PAGE AND ALL CORRECTIONS, IF ANY, BEAR MY INITIALS. <br /> I HAVE READ ]/HAVE BEEN READ [ ]THE FOREGOING DECLARATION AND UNDERSTAND THAT THIS <br /> HENT BE USED IN A COURT OF LAW. (S.TV‘i-?-----)--- <br /> P. i4 X1413 (a <br /> EC SIGNATURE) (OFFICE OR WITNESS SIGNATURE) <br /> a Qee44) \_-0 P I-li-moi <br /> (CITY AND STATE WHERE SIGNED) (DATE O STATEMENT) <br /> Page of (INIT.) <br /> PD-004 Re:7/2007 <br />