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9 EVERETT POLICE INCIDENT REPORTl" PAGE 1 OF (J <br /> INCIDENT CASE NUMBER <br /> D VUCSA/ WARRANT/DRUG LOITERING DD 12-3202 <br /> OCCURRED ON OCCURRED TO REPORTED ON <br /> MONTH DAY YEAR TIME MONTH DAY YEAR TIME MONTH DAY YEAR TIME <br /> A <br /> 2 18 2012. 1519 2 18 2012 1519 <br /> ADDRESS/LOCATION OF INCIDENT ❑ FORCE CODE POL.BEAT <br /> T 1122 BROADWAY AVE,EVERETT WA ®NO FORCE 351 11 <br /> LI OFFICER SAFETY RESP ASGN 0 JUVENILE ❑COMPUTER USED El HATE/BIAS <br /> OFFENSE <br /> A CODES VUCSA WAROTH ❑OFFICER ASS 0 CHILD ABUSE ®DRUG RELATED 0 ARSON-LOSS$ <br /> A❑C® AD C® 2 2 0 DOM.VIOLENCE ❑ALCOHOL RELATED ❑POSS.GANG REL. <br /> NO. PERSON'S NAME(LAST,FIRST,MIDDLE) RACE ETH SEX D.O.B./AGE HGT WGT EYES HAIR <br /> P <br /> 3 3 <br /> STREET ADDRESS AND APT NO. CITY STATE ZIP <br /> E <br /> RESIDENCE PHONE BUSINESS PHONE CELL PHONE EMPLOYMENT/OCCUP./SCHOOL HATE/BIAS VICTIM INJURY <br /> R ( ) ( ) ( ) <br /> 4 5 6 <br /> NO. PERSON'S NAME(LAST,FIRST,MIDDLE) RACE ETH SEX D.O.B./AGE HGT WGT EYES HAIR <br /> P <br /> 3 3 <br /> STREET ADDRESS AND APT NO. CITY STATE ZIP <br /> E <br /> RESIDENCE PHONE BUSINESS PHONE CELL PHONE EMPLOYMENT/OCCUP./SCHOOL HATE/BIAS VICTIM INJURY <br /> R ( ) ( ) ( ) <br /> 4 5 6 <br /> NO. CIN/IDENTIFICATION NO. BOOKED/WHERE LOCATION OF ARREST ARRESTEE ARMED WITH <br /> s Al . SNO COUNTY 1122 BROADWAY AVE ___ <br /> i1 ETH SEX HGT WGT EYES HAIR t- <br /> U N F 5'9 197 BLU BRN <br /> STATE <br /> S WA <br /> RESIDENCE PHONE BUSINESS PHONE EMPLOYMENT/OCCUPATION/SCHOOL <br /> P ( ) ( ) <br /> ALIAS NAME(S) DRIVER'S LIC./1.D.CARD STATE EXP <br /> E <br /> MISC. IDENTIFIERS <br /> I C <br /> CHARGES&CITATION#OR WARRANT#&AGENCY CHARGES&CITATION#OR WARRANT#&AGENCY <br /> T 1. D M 21 F CHARGE POSS CONT SUB Cr 2. 0 M ®F CHARGE POSS CONT SUB CIT <br /> NAME/RELATIONSHIP OF PERSON NOTIFIED(JUVENILE) DATE/TIME NOTIFIED NOTIFIED BY <br /> VEH.NO. STATE. YEAR MAKE MODEL STYLE COLOR <br /> V <br /> V1 WA 2000 HONDA CIV 3D BLACK <br /> SPECIAL IDENTIFYING FEATURES/V.I.N. DAMAGE$ REGISTERED OWNER'S NAME <br /> TORRALBA, DURAN, I <br /> ✓ VEH.NO. LICENSE NUMBER STATE YEAR MAKE MODEL STYLE COLOR <br /> SPECIAL IDENTIFYING FEATURES/V.I.N. DAMAGE$ REGISTERED OWNER'S NAME <br /> I certify(or declare under enalty of perjury under the laws of the State of Washington that the foregoing is true and correct. (RCW 9A.72.085.) <br /> OFFICER S1GNAA EDATE: FORCE USED FLEEING VEHICLE <br /> d//SCG AT EVERETT WASHINGTON z— f.8- 'L NO® YES 0 NO til <br /> OFFICER AC NAME/NUMBER1334UNIT [ APP OVED <br /> /B PERS.NIL. • <br /> N.WALLACE 1334 <br /> CLEARANCE: DISTRIBUTION: OTHER: A � ` LOG •-❑ ❑ ❑ <br /> UNFOUNDED ❑ � <br /> DV JUV TRAF <br /> ❑ ARR/A V/ <br /> ❑ EXC/A ❑ PA / P. <br /> ❑CPS ❑HD ❑ DET ,/ ' <br /> ❑ ARR/J ❑ ADMIN es i D• NI, •LS <br /> ❑ EXC/J ❑DSHS ❑MH ❑ PAT <br /> • <br /> 1. ❑ ENTERED RMS ( ❑ENTERED WACIC/NCIC / ❑CLy' - • "ACIC/NCIC / <br /> ATE I IT LS DATE INITIALS DATE INITIALS <br /> PD 03(REV.6/08 JML) FORM ID:IRF00.07.W95 <br />