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- — _ _ _ � <br /> ����i�' EVERETT POLICE DEPARTMENT F���~^ <br /> '�" VEt11CLE REPORT � L 2 <br /> RWE_0:_ <br /> , INLIDEM CASENU'ADERFT'-'� <br /> �� ❑ AUTOTHEFf ❑ RECOVERY IMPOUND O THEFT OF PLATES DD <br /> 7 <br /> i�; - - • "'"`-r""—�-_' — <br /> .i: .. . . . . . ::�_rl�F !;:,:�. u � '.�Fip.... ;;<. �.,,..� ,� ?e:� , �, ':� r ;r- p �, ., ,.. .... <br /> . ._ r�..... <br /> � � -'...�:c.=���-777.---���r 0��1�..' ,. . _._ _.� , „_ ,_ � .:�.. <br /> ���MOYTH I u0.Y YEAR TME MOMH �AY YEAR TIME MOI{TFi OAV^ Y�R TI�� <br /> i€: � !L v S � <br /> A; cooe POl10E BEAT <br /> ADORESS/LOC TONOFINCIDENT <br /> '� l 22� fW� � 1Z�2'I� �� ,l.J�} , 4 <br /> � �'�:l+�i� ❑OFFICERSAFETV AESP ASGN ❑JWENILE ❑CAMPUTERUSED ❑HATFIBIAS i <br /> ❑OFFICER ASSAULT ❑LMILD ABUSE Q ORUG F7EUTE� ❑ARSON{OSS � <br /> =r"':��'� A C A C t 2 ❑DOMESi1C VIOLENC'E C�pLCANOL REIATED <br /> :.:: ................_. <br /> N ^ NAf/�� sIBT.FIA$LNIDOLE�� .I� RpCE , E7H , SQ( Q,.^;G�� NGT WGT EVES H <br /> Iti //Mil /V L' <br /> L .Y ILS/ �^' N � v�0 <br /> ST ETAO�flES APLY CITY STATE <br /> Z932 �3 qT� PL. S� �"1 I11� �',2�J� �1- ��12 <br /> P RESIDENLEPMONE CELIPNONE E�MAILADORE55 WVE/,B�S, VICTI� INJ�� 6 <br /> R � � � � U <br /> S WORK PMONE OCCl1PAT10N AND EMPLOYFA <br /> 0 ( � <br /> N <br /> ALTERNATE W NTAGT PER504 FELATIONSHIP <br /> RESIDENCEPMONE C/ELLPHONE W/OHKPHUWE EMPLOYER <br /> � � l � 1 � <br /> -;`- NO. CIY/IDENTIFlCATIONNO. BOOKEO/WHFAE LOCATIONOF�RREST MRESTEEARMEDWfTH <br /> �'a <br /> ='° yAtAE(UST,FIRST,MiDDL.E) HACE EfF1 SE% D.0.9./AGE MGT WG7 EYES HAIR <br /> ' � a <br /> ',-.i'�. STiiEETA�DRE$S APLN Q7Y STATE ZIP <br /> 3;1; <br /> '�� RESIDENCEPHONE DUSINESSPHONE EMPLOYtLEM/OCCIIPATIONlSC:100L <br /> �& � ) � ) <br /> '�'� AlJASNAlAE�S) SOC.SEC.NUTABER ORIVER'SLIC.ILD.CFRD STATE IXP <br /> :�: <br /> Q�� _ <br /> ��'T�' MISG IOENi7FlERS <br /> ;i:'.= <br /> r:;si <br /> :r.= <br /> ="-� CHARGES 8 CITATION p ON WARRANT p 8 AGENCY CHAflGES&GITATIOY�OR WARRANT tl 8 AGENCY <br /> == 1. M F 2. M F <br /> �: NAME/REV110NSHIPOFPERSONNOTIFIEO(JWEMLE) DATE/TiMENOTIFIED NOiiFIEDOY <br /> ��.: <br /> PEASOt1F-0RIMPOUN/D�,� ,�,,(T�� Q�1` � ^ � .�-y�� �--/--' HOLD ❑ NAqLS SUPV.INIT./FERSN <br /> _E _ILL�I C LY�..�$ 8i1`� P N v� �y�J C�Jv 1 FOR ❑ TaAF � <br /> H VEN.NU. L�NS�R � TA� L�GYR LIC�TYPnE� YFJ�R I2 ��E ,� lAQDEL � SN` �� COL�� <br /> �� %1� {t �,Yf T <br /> R VIN/H�Na.z C S�$CF 331�� A��E S TOW pjiNE 'S SIG NR TGW COMPANY <br /> // �-- <br /> R j — llL� — <br /> SPECIAL IDENTIryING FEATURES E.P�INPOUNO LOT <br /> B SPACE 4 <br /> 0 — <br /> A LaCKEo REYS iN OELINO. VIC771d iHEFf URNL� REG.OWNER SPECiFY OAMaGE BY 5 � � f\ DAIAAGE ES? <br /> 7 VEI{� PAVMLNT CONSEIJT INS. P�LE NOT1FlcD7 SIIADINGOAMAGEDPREA 4 4 Z y � <br /> y � Y 1 Y N V N Y N Y N V N TOP IINDERSIDE <br /> STATEMENT OF PERSON REPOR'flt�G: <br /> I did nol give anyone permission to Ipke or use Ne descnhed vehicla.I am Ihe ownar or person�vho was leg�lly in possessinn oi tlio tloscrihed vehide,and 1 will lesGty in coun <br /> undet oath to��e tacts herein.I tuMer grant wartanlless antry iNo oll portions of Ne vehicla and permisslon lor palice oHicors to�veamine anNor selzo any rtems o1 ev�dentlary <br /> valuo pursuaN to the invastigation ol Nis maner.I have read antl undere.tnnd tho responso entl impountl policy deunbed an the back ol Nis puge.t cerLly(or Aalore)unGor <br /> penalty ol perjurY ol Ihe laws ol tho Slale ol Washington thal Iho bregoing is true ana corteq.II t�is is nat Iruo and corteci,I understand that I may be chergod with vlolaGon <br /> ol Everetl Municipal Code f0.12.160,Inifialing a Felse Foport <br /> SIGNATUREOFpEHSONFEPORTING X ATEVERETT.VlASNINGTON OATE nME <br /> OFFICEflNAME/ UMdER UNIT APPROVEDBY:/PERSNO. <br /> l�/�y�f ���Y�_�� � v� i (�Y <br /> CLEARANCE: ❑UNFOUNDED OIS��BUT10M ❑JUV ❑ TW1F OT11ER: LOGGED: <br /> ',] APfUA ❑FJ(C/A ❑ PA ❑CPS ❑HD ❑ DEf � �,�/3�/G_ <br /> ❑ ARq/J ❑E%C/J ❑ ADh1IN ❑ DSHS ❑MH ❑ PAT �O� (t�vF1L E�lAL �� / �+mF� <br /> QENTEHEDRtdS / ❑ENTEFEOWAqClNCIC _ oq� � INm� ❑CLEAflLDWAGClNCIC � �ixmas <br /> OALE �NITIALS <br /> � f9b�NEV 2Y3� <br />