offense-incident report n 1 m holmes beach...
TRANSCRIPT
Holmes Beach Police Department
FL0410400
26
00
0859
1 1 1
STATE
2018 NE FLORIDIAN CIR. 34266ARCADIA
LABORER
NONE
SHIRT / JEANS NONE
5-07 175
0859 0859 0920
0859 0859
32
20170707
MEXICO
OF FLORIDA
DRIVERS LICENSE
Thu Thu
Thu
1V 5
RANGEL FRIAS JUAN ANTONIO1 2A
MW BRO BLK
FL
M S
LT MED M
FL
03 1 90004 322CDRIVERS LIC
___-_______
___-__-____
___ ___-____
___-_______
___ ___-____
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___ ___-____
34217 W80
ROADWAY
PALM DRIVE HOLMES BEACH6700
0 0
I RAN TAG (EEFR40)THAT WAS AFFIXED TO LINCOLN. THE FCIC/NCIC QUERY STATED THE REGISTERED OWNERDID NOT HAVE A VALID LICENSE. I RAN HIS NAME THROUGH IN-CAR FCIC/NCIC AND CONFIRMED IT. I INITIATED ATRAFFIC STOP ON VEHICLE AND DRIVER WAS THE REGISTERED OWNER. I WAS GIVEN A MEXICAN CONSULAR CARD ANDEXPIRED INSURANCE. I ISSUED DRIVER A SUMMONS TO APPEAR FOR NO LICENSE AND A CIVIL CITATION FOR NOPROOF OF INSURANCE. DRIVER SIGNED OUR COPY OF THE SUMMONS.
PATROL
11
JASON HIGGINS
SGT.K.POWERS 320
331
1
EV
EN
TD
AT
AN
AR
RA
TIV
ES
US
PE
CT
00. N/A01. Gunshot02. Stabbed
CO
DE
SA
DM
A-Attempted
C-Committed
A-Attempted
C-Committed
Area
Type of Weapon
01. Residence Single
02. Apartment/Condo
03. Residence-Other
04. Hotel/Motel
Time (mil)
Time Dispatched (mil)
Primary Offense Description
21. Employer22. Landlord/Tenant23. Acquaintance99. Other Known
5. Ordinance
9. Other
Zone
)
Agency Report Number
3. Misdemeanor
4. Traffic Misdemeanor
OFF/INC
# 2
OFF/INC
# 1
Business Name/Area Identifier
District
NCIC/UCR Code
2. No
Location Type
V/W Code
# Victims
00. N/A01. Handgun
05. Knife/CuttingInstrument
06. Blunt Object
07. Hands/Fist/Feet08. Poison09. Explosives
10. Fire/Incendiary11. Threat/Intimidation12. Simulated Weapon
V - VictimW - WitnessC - Reporting Person
O - Other
Race
N - N/AM - MaleF - FemaleU - Unknown
Residence Type
0. N/A1. City2. County
Extent of InjuryResidence Status
03. Laceration04. Unconscious05. Poss. Broken Bones06. Poss. Internal Injury
Victim Relationship To Offender07. Loss of Teeth08. Burns09. Abrasions/Bruises99. Other
06. Parent07. Brother/Sister08. Child09. Step-Parent
10. Step-Child11. In-Law12. Other Family13. Student
V/W Code # Name (Last, First, Middle or Business) Residence Phone
Business Phone
Race Sex Injury Type(s) Relationship Ethnicity Will Victim prefer charge?
Synopsis of Involvement
Residence Phone
Business Phone
Juvenile
Occupation
Sex Date of Birth Height Weight Eye Color Hair Length Hair Style
Nickname/Street Name Place of Birth
Social Security Number
SCIC/NCIC
Employer/School
Teeth Speech/Voice Special Identifiers
Original DayReported
Date Time (mil) Time Arrived (mil) Time Completed (mil)
1. Felony
2. Traffic Felony To
Time (mil)
(-
Type
30. Other Mobile
99. Other
15. Industrial/Mfg.
16. Storage
17. Gov't/Public Bldg.
18. School/University
19. Jail/Prison
20. Religious Bldg.
21. Airport
22. Bus/Rail Terminal
23. Construction Site
24. Other Structure
25. Parking Lot/Garage
26. Highway/Roadway
27. Park/Woodlands/Field
28. Lake/Waterway
29. Motor Vehicle
10. Dept/Discount Store
11. Specialty Store
12. Drug Store/Hospital
13. Bank/Financial Inst.
14. Commercial/Office Bldg.
Suspect Code
Incident Location (Street Number, Street, Apt,)
Scars/Marks/Tatoos (Location/Describe)
0. N/A
1. Occupied
E-EscapeeZ-Other
From
Date of Supplement
- (
17. Friend18. Neighbor19. Sitter/Day Care20. Employee
V/W Code # Name (Last, First, Middle or Business) Residence Phone
Business Phone
Race Sex Injury Type(s) Relationship Ethnicity Will Victim prefer charge?
Synopsis of Involvement
V. Type
OFF/INC Indicator
OBTS Number (Arrested)Other I.D. NumberImmigration and Naturalization Number
Incident Type Incident: Day Date
2. Unoccupied
3. Abandoned
05. Convenience Store
06. Gas Station
07. Liquor Sales
08. Bar/Nightclub
09. Supermarket
DateDay
0. N/A
1. Yes
Forced Entry Occupancy
Statute Violation Number - Chapter, Section, SubDescriptionType
Hair ColorRace
Facial HairBuildComplexion
Driver's License Number/State
Address
Code
Maiden Name
Name (Last, First, Middle)
Extent of InjuryRes. StatusRes. Type
ZipStateCity
Extent of InjuryRes. StatusRes. Type
ZipStateCity
13. Drugs88. Unknown99. Other
Grid
Victim Type
0. N/A1. Juvenile2. L.E. Officer3. Adult
4. Business5. Government6. Church9. Other
Sex
I - American IndianO - Oriental/AsianU - Unknown
N - N/AW - WhiteB - Black
3. Florida4. Out-of-State
0. N/A1. Full Year2. Part Year3. Non-Resident
0. None1. Minor2. Serious3. Fatal
14. Teacher15. Child of Boy/Girl
Friend16. Boy/Girl Friend
03. Spouse04. Ex-Spouse05. Co-Habitant
00. N/A01. Undetermined02. Stranger
Injury Type
Clothing (Describe)
ZipStateCity
02. Rifle03. Shotgun04. Firearm
Susp. #
VIC
TIM
/W
ITN
ES
SV
ICT
IM/W
ITN
ES
S
# Prem. Ent.
S-SuspectA-Arrestee
Dom. Violence
Dom. Violence
ZipCity
# OFF/INC. # Offenders # Veh. Stolen
1.#12.#2
3.Both
)
Age
Date of Birth Age
Date of Birth Age
Address (Street, Apt. Number)
Other Contact Info. (Time Available, Interpreter, etc.)
Address (Street, Apt. Number)
Other Contact Info. (Time Available, Interpreter, etc.)
Last Known Address (Street, Apt. Number)
V. TypeOFF/INC Indicator
If V/W Code isV, W or C
Fill in this Line
1.#12.#2
3.Both
OFF/INC Indicator
If V/W Code isV, W or C
Fill in this Line
1.#12.#2
3.Both
Person/Unit Notified
Case Status
Time
Routed To Referred
Related Report Number(s)
Unit
of
Page
Number ArrestedClearance Type
Exception Type 2. Arrest on Primary OffenseSecondary Offense Without Prosecution
3. Death of Offender4. V / W Refused to Cooperate
3.Unfounded
Page
Date
5. Prosecution Declined6. Juvenile/No Custody1.Extradition Declined
1.Arrest2.Exceptional
Jail Number
OBTS Number
Date Cleared
ByAssigned To
AD
MIN
IST
RA
TIV
E
A-AdultJ-Juvenile
Date
Name of Officer Reporting
Officer Reviewing (If Applicable) I.D. Number
I.D. Number/Locator Code
1. Original2. Supplement
Juvenilein Report
JuvenileWarn/Dismiss
1
__/__/____
08/24/2017
08/24/2017 08/24/2017
__/__/____
08/24/2017
__/__/____
11/10/1984
Signature of Officer Reporting
Signature of Officer Reviewing
Yes No
YYeess NNoo
12 NOFFENSE-INCIDENT REPORTGangRelated
C O P
Y
2. No
FL0410400
26
00
2050
2 1 1 0 0
VICKERS
5610 SOLITARE PALM WAY 33572APOLLO BEACH
UNEMPLOYED
V262165853790
606 250
Holmes Beach Police Department
2050 2050 2300
2050 2300
31
20170709
FLORIDA
DAVID EARL
DWLSR
1
Thu
Thu Thu
1 STATE OF FLORIDA
2 NN
MW
V 5
2A
BLU BLD
0 0 0 00 0000
FL
LT MUS
FL
BORES
SGT.COPEMAN 307
34 2c 9000
13 6b 350ACMARIJUANA-POSSE
322
893
CDRIVERS LIC
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S X
34217GULF DR HOLMES BEACH3101
0 0
3
2
3
326
3
SHORTS AND TEE SHIRT BODY TATTOOS
N2 1
00. N/A
01. Gunshot
02. Stabbed
OFF/INC Indicator
EV
EN
TD
AT
AN
AR
RA
TIV
ES
US
PE
CT
CO
DE
SA
DM
A-AttemptedC-Committed
A-AttemptedC-Committed
Area
Type of Weapon
01. Residence Single02. Apartment/Condo03. Residence-Other04. Hotel/Motel
Time (mil)
GangRelated
Time Dispatched (mil)
Primary Offense Description
21. Employer
22. Landlord/Tenant
23. Acquaintance
99. Other Known
5. Ordinance9. Other
Zone
)
Agency Report Number
3. Misdemeanor4. Traffic Misdemeanor
OFF/INC# 1
Business Name/Area Identifier
District
NCIC/UCR Code
Location Type
V/W Code
# Victims
00. N/A01. Handgun
05. Knife/CuttingInstrument
06. Blunt Object
07. Hands/Fist/Feet08. Poison09. Explosives
10. Fire/Incendiary11. Threat/Intimidation12. Simulated Weapon
V - Victim
W - Witness
C - Reporting Person
O - Other
Race
N - N/A
M - Male
F - Female
U - Unknown
Residence Type
0. N/A
1. City
2. County
Extent of InjuryResidence Status
03. Laceration
04. Unconscious
05. Poss. Broken Bones
06. Poss. Internal Injury
Victim Relationship To Offender07. Loss of Teeth
08. Burns
09. Abrasions/Bruises
99. Other
06. Parent
07. Brother/Sister
08. Child
09. Step-Parent
10. Step-Child
11. In-Law
12. Other Family
13. Student
Residence Phone
Business Phone
Juvenille
Occupation
Sex Date of Birth Height Weight Eye Color Hair Length Hair Style
Nickname/Street Name Place of Birth
Social Security Number
SCIC/NCIC
Employer/School
Teeth Speech/Voice Special Identifiers
Original DayReported
Date Time (mil) Time Arrived (mil) Time Completed (mil)
1. Felony2. Traffic Felony To
Time (mil)
(-
Type
15. Industrial/Mfg.16. Storage17. Gov't/Public Bldg.18. School/University19. Jail/Prison
20. Religious Bldg.21. Airport22. Bus/Rail Terminal23. Construction Site24. Other Structure
25. Parking Lot/Garage26. Highway/Roadway27. Park/Woodlands/Field28. Lake/Waterway29. Motor Vehicle
10. Dept/Discount Store11. Specialty Store12. Drug Store/Hospital13. Bank/Financial Inst.14. Commercial/Office Bldg.
Suspect Code
Incident Location (Street Number, Street, Apt,)
Scars/Marks/Tatoos (Location/Describe)
OFFENSE-INCIDENT REPORT
0. N/A1. Occupied
E-EscapeeM-Missing
From
Date of Supplement
- (
17. Friend
18. Neighbor
19. Sitter/Day Care
20. Employee
OFF/INC Indicator
OBTS Number (Arrested)Other I.D. NumberImmigration and Naturalization Number
Incident Type Incident: Day Date
2. Unoccupied3. Abandoned
05. Convenience Store06. Gas Station07. Liquor Sales08. Bar/Nightclub09. Supermarket
DateDay
0. N/A1. Yes
Forced Entry Occupancy
Statute Violation Number - Chapter, Section, SubDescriptionType
Hair ColorRace
Facial HairBuildComplexion
Driver's License Number/State
Address
Code
Maiden Name
Name (Last, First, Middle)
13. Drugs88. Unknown99. Other
Grid
Victim Type0. N/A
1. Juvenile
2. L.E. Officer
3. Adult
4. Business
5. Government
6. Church
9. Other
Sex
I - American Indian
O - Oriental/Asian
U - Unknown
N - N/A
W - White
B - Black
3. Florida
4. Out-of-State
0. N/A
1. Full Year
2. Part Year
3. Non-Resident
0. None
1. Minor
2. Serious
3. Fatal
14. Teacher
15. Child of Boy/Girl
Friend
16. Boy/Girl Friend
03. Spouse
04. Ex-Spouse
05. Co-Habitant
00. N/A
01. Undetermined
02. Stranger
Injury Type
Clothing (Describe)
ZipStateCity
02. Rifle03. Shotgun04. Firearm
# Prem. Ent.
S-SuspectA-Arrestee
ZipCity
# OFF/INC. # Offenders # Veh. Stolen
1.#12.#2
3.Both
)
If V/W Code isV, W or C
Fill in this LineOFF/INC Indicator
V/W Code # Name (Last, First, Middle or Business) Residence Phone
Business Phone
Race Sex Injury Type(s) Relationship Ethnicity Will Victim prefer charge?
Synopsis of Involvement
V. Type
V/W Code # Name (Last, First, Middle or Business) Residence Phone
Business Phone
Race Sex Injury Type(s) Relationship Ethnicity Will Victim prefer charge?
Synopsis of Involvement
V. Type
Extent of InjuryRes. StatusRes. Type
ZipStateCity
Extent of InjuryRes. StatusRes. Type
ZipStateCity
VIC
TIM
/W
ITN
ES
SV
ICT
IM/W
ITN
ES
S
Dom. Violence
Dom. Violence
1.#12.#2
3.Both
1.#12.#2
3.Both
Date of Birth Age
Date of Birth Age
If V/W Code isV, W or C
Fill in this Line
Address (Street, Apt. Number)
Other Contact Info. (Time Available, Interpreter, etc.)
Address (Street, Apt. Number)
Other Contact Info. (Time Available, Interpreter, etc.)
Last Known Address (Street, Apt. Number)
OFF/INC# 2
R-Rec. MissingZ-other
Age
Person/Unit Notified
Case Status
Time
Routed To Referred To
Related Report Number(s)
Unit
of
Page
Number ArrestedClearance Type
Exception Type2. Arrest on Primary Offense
Secondary Offense Without Prosecution3. Death of Offender4. V / W Refused to Cooperate
3.Unfounded
Page5. Prosecution Declined6. Juvenile/No Custody1.Extradition Declined
1.Arrest2.Exceptional
Jail Number
OBTS Number
Date Cleared
AD
MIN
IST
RA
TIV
E
A-AdultJ-Juvenile
Date
Name of Officer Reporting
Officer Reviewing (If Applicable) I.D. Number
I.D. Number/Locator Code
By DateAssigned To
30. Other Mobile99. Other
Susp.#
JuvenileWarn/Dismiss:
1. Original2. Supplement:
Juvenilein Report:
08/24/2017
08/24/2017 08/24/2017
__/__/____
08/25/2017
__/__/____
__/__/____
USA Rev. 01/23/2003
10/19/1985
Signature of Officer Reviewing
Signature of Officer Reporting
SEE NARRATIVE PAGE..
Yes No
YYeess NNoo
C O P
Y
Holmes Beach Police Department 20170709
N 1
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326
SGT.COPEMAN
BORES
307
DWLSR STATE OF FLORIDA
CO
DE
SA
DM
Juvenilein Report:
Date of Supplement
Primary Offense Description
Victim Type Race
Victim Relationship To Offender
Agency Report Number
Residence Type Residence Status4. Business5. Government6. Church9. Other
SexN-N/AM-MaleF-FemaleU-Unknown
0. N/A1. City2. County
3. Florida4. Out-of-State
0. N/A1. Full Year2. Part Year3. Non-Resident
0. None1. Minor2. Serious3. Fatal
07. Loss of Teeth08. Burns09. Abrasions/Bruises99. Other
00. N/A01. Undetermined02. Stranger
03. Spouse04. Ex-Spouse05. Co-Habitant
06. Parent07. Brother/Sister08. Child09. Step-Parent
14. Teacher15. Child of Boy/Girl Friend16. Boy/Girl Friend
17. Friend18. Neighbor19. Sitter/Day Care20. Employee
21. Employer22. Landlord/Tenant23. Acquaintance99. Other Known
PERSON(S) REPORT
Injury Type
00. N/A01. Gunshot02. Stabbed
Original Date
1. Original2. Supplement:
0. N/A1. Juvenile2. L.E. Officer3. Adult
N-N/AW-WhiteB-Black
I-American IndianO-Oriental/AsianU-Unknown
03. Laceration04. Unconscious05. Poss. Broken Bones06. Poss. Internal Injury
10. Step-Child11. In-Law12. Other Family13. Student
Victim #1 Name (Last, First, Middle)
V/W Code
V - VictimW - WitnessC - Reporting Person
O - Other
Will Victim prefer charge?
Will Victim prefer charge?
Extent of Injury
SU
SP
EC
TO
RM
ISS
ING
PE
RS
ON
S
If V/W Code isV, W or C
Fill in this LineOFF/INC Indicator
OFF/INC Indicator V/W Code # Name (Last, First, Middle or Business) Residence Phone
Business Phone
Race Sex Injury Type(s) Relationship Ethnicity
Synopsis of Involvement
V. Type
V/W Code # Name (Last, First, Middle or Business) Residence Phone
Business Phone
Race Sex Relationship Ethnicity
Synopsis of Involvement
Extent of InjuryRes. StatusRes. Type
ZipStateCity
Extent of InjuryRes. StatusRes. Type
ZipStateCity
VIC
TIM
/W
ITN
ES
SV
ICT
IM/W
ITN
ES
S
Dom. Violence
Dom. Violence
1.#12.#2
3.Both
1.#12.#2 3.Both
Date of Birth Age
Date of Birth Age
If V/W Code isV, W or C
Fill in this Line
Address (Street, Apt. Number)
Address (Street, Apt. Number)
Other Contact Info. (Time Available, Interpreter, etc.)
Other Contact Info. (Time Available, Interpreter, etc.)
SU
SP
EC
TO
RM
ISS
ING
PE
RS
ON
S
Hair Color
Suspect Code Code
Maiden Name
Occupation
Driver's License State/Number
Employer/School
Immigration and Naturalization Number Other ID. Number
Address
Place of Birth Residence Phone
Business Phone
Social Security Number
OBTS Number
Date of Birth or Age Height
Complexion Facial Hair Teeth Speech/Voice Special Identifiers
Eye Color Hair Length Hair Style
Name (Last, First, Middle)
Clothing (Describe)
Last Known Address (Street, Apt. Number)
OFF/INC Indicator
1.#12.#2
Sex
Nickname/Street Name
SCIC/NCIC
WeightRace
Juvenile
Build
3.Both
City
Maiden Name
Occupation
Driver's License State/Number
Employer/School
Immigration and Naturalization Number Other ID. Number
Address
Place of Birth Residence Phone
Business Phone
Social Security Number
OBTS Number
Date of Birth Height
Complexion Facial Hair Teeth Speech/Voice Special Identifiers
Eye Color Hair Length Hair Style
State Zip
Clothing (Describe)
Last Known Address (Street, Apt. Number)
Sex
Nickname/Street Name
SCIC/NCIC
Hair ColorWeightRace
Build
Code Name (Last, First, Middle)OFF/INC Indicator
1.#12.#2
Juvenile
3.Both
Susp. #
E-EscapeeM-Missing
Suspect Code
S-SuspectA-Arrestee
R-Rec. MissingZ-other
Susp. #
Age
V. Type
E-EscapeeM-Missing
S-SuspectA-Arrestee
R-Rec. MissingZ-other
Injury Type(s)
ZipStateCity
Scars/Marks/Tatoos (Location/Describe)
Scars/Marks/Tatoos (Location/Describe)
MIS
SIN
GP
ER
SO
N/
RU
NA
WA
Y 7. VoluntaryAdult
8. Unknown
1. Yes2. No8. Unknown
Incident Type
1. Runaway2. Parental3. Involuntary
Foul Play Suspected ?
1. Yes2. No
Missing Before ?
1. Yes2. No8. Unknown
1. Yes2. No8. Unknown
1. Yes2. No8. Unknown
MCIC Form Provided ?
4. Disabled5. Endangered6. Disaster Victim
Fingerprints Available? Dental Record Available
1. Yes2. No
Photo Available?
Date Last Seen Time Last Seen Accompanied By
Property Carried
Probable Destination
Medication Required/Type
ID. Type/Number
Recovery Information7. Deceased9. Other
Doctor/Dentist (Name, Phone Number)
Transportation Mode
Location Last Seen (Address, City, St.)
5. Law Enforcement Custody6. Returned to Parent
3. Hospitalized4. HRS Custody
2. Located-Not Returned
0. N/A1. Voluntary
Name/Address
ID. Type/Number
Mental/Physical Condition
AD
MIN
IST
RA
TIV
E
ID. Number(s)/Locator code Unit
DateID. Number Routed To Referred To Assigned To
Officer(s) Reporting Date
By
of
PagePage
Officer Reviewing (If Applicable)
Signature of Officer Reporting
__/__/____
08/25/2017
__/__/____
08/24/2017
USA Rev. 01/23/2003
__/__/____
Signature of Officer Reviewing
YYeess NNoo
YYeess NNoo
C O P
Y
Type
Type
Type
Code Person
Code Person
Code Person
Code Person
Code Person
Holmes Beach Police Department20170709
1
BURNT MARIJUANA BLUNT
1 MARIJUANA1
1
CELL PHONE
2 CELL PHONE1
9
A 0
D
Z
8
8
0.00
0.00
326
SGT.COPEMAN
BORES
307
1
DWLSR STATE OF FLORIDA
A
TH
EF
TA
DM
A. Auto Accessory/PartsB. BicycleC. Camera/Photo EquipmentD. Drug
T. TV/Video/VCRU. Currency/NegotiableV. Credit Card/Non-NegotiableW. Boat MotorX. Structure
Property TypeO. Office EquipmentP. Art/CollectionQ. Computer EquipmentR. Radio/StereoS. Sports Equipment
E. Equipment/Tool.F. Food/Liquor/ConsumableG. GunH. Household Appliance/GoodsI. Plant/Citrus
J. Jewelry/Precious MetalK. Clothing/FurL. LivestockM. Musical InstrumentN. Construction Machinery
Date of Supplement
Original Date Reported Primary Offense Description Victim #1 Name (Last, First, Middle)
Agency Report Number
1. Original2. SupplementPROPERTY REPORT
Y. Farm EquipmentZ. Miscellaneous
PR
OP
.D
ET
AIL
/N
AR
R.
CO
DE
S
09. From Vehicle10. Extortion
Theft Type Codes
04. Pocket Picking05. Purse Snatching
06. Embezzlement07. From Coin Oper. Machine
08. From PublicAccess Building
11. By Computer12. Fraud
99. Other00. N/A01. Burglary
02. Robbery03. Shoplifting
Theft Type
A - ArresteeO - Other
1. Stolen2. Recovered
V - VictimS - Suspect
5. Lost6. Found
Person Codes Status Codes
3. Stolen and Recovered4. Recovered for Other Jurisdiction
2. Criminal Mischief3. During other Offense
7. Safekeeping8. Evidence/Seized
9. Other9. Other
Damage Codes
0. N/A1. Arson
PR
OP
ER
TY
Serial Number
NameItem # Status Damage Property Type Quantity Brand Model Name/Number
Owner Applied Number Description (Size, Color, Caliber, Barrel Length, Etc. )
Value Value Recovered Date Recovered SCIC/NCIC
PropertyStolen
PropertyRecovered
Change in PropertyStolen Value
Change in PropertyRecovered Value
Activity Type Unit
Activity Description Quantity Unit
P. PossessS. SellB. BuyT. Traffic
R. SmuggleD. DeliverE. UseK. Dispense/Distribute
M. Manufacture/Produce/CultivateZ. Other
A. AmphetamineB. BarbiturateC. CocaineE. Heroin
H. HallucinogenM. MarijuanaO. Opium/DerivativeP. Paraphernalia/Equipment
S. SyntheticU. UnknownZ. Other
1. Gram2. Milligram3. Kilogram4. Ounce
5. Pound6. Ton7. Liter8. Milliliter
Estimated Street Value
TO
TA
LS
CO
DE
SD
RU
GS
PR
OP
ER
TY
Serial Number
NameItem # Status Damage Property Type Quantity BrandModel Name/Number
Owner Applied Number Description (Size, Color, Caliber, Barrel Length, Etc. )
Value Value Recovered Date Recovered SCIC/NCIC
PR
OP
ER
TY
Serial Number
NameItem # Status Damage Property Type Quantity Brand Model Name/Number
Owner Applied Number Description (Size, Color, Caliber, Barrel Length, Etc. )
Value Value Recovered Date Recovered SCIC/NCIC
PR
OP
ER
TY
Serial Number
NameItem # Status Damage Property Type Quantity Brand Model Name/Number
Owner Applied Number Description (Size, Color, Caliber, Barrel Length, Etc. )
Value Value Recovered Date Recovered SCIC/NCIC
PR
OP
ER
TY
Serial Number
NameItem # Status Damage Property Type Quantity Brand Model Name/Number
Owner Applied Number Description (Size, Color, Caliber, Barrel Length, Etc. )
Value Value Recovered Date Recovered SCIC/NCIC
Activity Description Quantity Unit Estimated Street Value
Activity Description Quantity Unit Estimated Street Value
AD
MIN
IST
RA
TIV
E
ID. Number(s)/Locator code Unit
DateID. Number Routed To Referred To Assigned To
Officer(s) Reporting Date
By
of
PagePage
Officer Reviewing (If Applicable)
Signature of Officer Reviewing
Signature of Officer Reporting
9. Dose Unit/Item
__/__/____
08/24/2017
__/__/____
__/__/____
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C O P
Y
AD
M
1100.. OOtthheerr -- SSppeecc..66.. TTrraannss..
77.. EEnnggiinnee PPaarrttss
1. Key
11.. KKeeyy
3. Hot Wire
6. Trans.
7. Engine Parts
8. Major Body Parts
VE
HIC
LE
/V
ES
SE
L1. Original2. Supplement
Date of Supplement
Reg. State
Date Recovered
LengthVessel Name
StyleModelStatusPerson #
1. Local / Local
2. Local / Other
3. Other / Local
Tag Type
Primary Offense Description Victim #1 Name (Last, First, Middle)
Person Code Status Code Damage Code Type Recovery Location Recovery Code
Stolen / Recovered
Holmes Beach Police Department
1. Stolen2. Recovered3. Stolen and
Recovered4. Suspicious
5. Impounded6. Abandoned7. Fail Return8. Seized9. Other
0. N / A1. Arson2. Criminal Mischief3. During Other Offense
1. Auto2. Truck / Van3. Motorcycle4. Camper / RV5. Bus
6. Trailer7. Boat8. Aircraft9. Other
VEHICLE REPORT
Original Date Reported
Agency Report Number
Description (Identifying Characteristics, Noticeable Damage, Interior Color, etc)
Tag Reg./Doc. # Reg. Year Decal Number
VIN/Hull/FAA Estimated Value
Propulsion
Insurance Company Lien HolderCondition
Hull Material Boat Type
Recovery Address/Geographic Indicator
Recovery Loc. Recovery Code Original Reporting Agency Report Number Reason/Authority
SCIC/NCIC Location of Original Theft
Value Recovered
1. Window Closed
708PMX
2G4WC582461289641
2. Locked 3. Keys in Ignition
WHITE
Color (Top/Bottom)
Towed By
Components Stripped
0. N/A 5. Interior 9. Tag/Decal Stolen
10. Other - Spec.0. N/A 8. Unk.2. Tow Truck 4. Steering
5. Ignition 1. VIN Plt.
4. Battery
Person Code Damage Type Year Make
2006 BUICK 4DR 4DR
Storage Location
V- VictimS- SuspectA- ArresteeO- Other
5. Park / Playground6. Shopping Mall7. Woods8. Water9. Other
1. Family Residence2. Apt. Complex3. Housing Project4. Commercial /
Industrial
4. Stripped / TheftFrom
9. Other
CO
DE
SV
EH
ICL
E/V
ES
SE
LV
EH
ICL
EIN
V./N
AR
RA
TIV
E
Person Code Person # Status Damage StyleModelType Year Make
Reg. State Tag TypeTag Reg./Doc. # Reg. Year Decal Number
VIN/Hull/FAA Estimated Value
Insurance Company Lien HolderCondition
1. Window Closed1. Window Closed 2. Locked2. Locked 3. Keys in Ignition3. Keys in Ignition
Description (Identifying Characteristics, Noticeable Damage, Interior Color, etc)Color (Top/Bottom)
LengthVessel Name PropulsionHull Material Boat Type
Date RecoveredRecovery Address/Geographic Indicator Value Recovered
Recovery Loc. Recovery Code Original Reporting Agency Report Number Reason/Authority
Methodof Theft
00.. NN//AA 88.. UUnnkk..22.. TTooww TTrruucckk
33.. HHoott WWiirree
44.. SStteeeerriinngg
55.. IIggnniittiioonn
Components Stripped
00.. NN//AA 55.. IInntteerriioorr
88.. MMaajjoorr BBooddyy PPaarrttss
99.. TTaagg//DDeeccaall SSttoolleenn11.. VVIINN PPlltt..
44.. BBaatttteerryy
Location of Original TheftTowed By Storage Location SCIC/NCIC
Vehicle #
HoldY - YesN - No
HoldY - YesN - No
Vehicle #
Methodof Theft
2. Tires/Wheels
3. Radio/CB
22.. TTiirreess//WWhheeeellss
33.. RRaaddiioo//CCBB
FL
Case Status
Routed To Referred To
Unit
of
Page
Number ArrestedClearance Type
Exception Type 2. Arrest on Primary OffenseSecondary Offense Without Prosecution
3. Death of Offender4. V / W Refused to Cooperate
3.Unfounded
Page
Date
5. Prosecution Declined6. Juvenile Custody1.Extradition Declined
1.Arrest2.Exceptional
OBTS Number
Date Cleared
ByAssigned To
AD
MIN
IST
RA
TIV
E
A-AdultJ-Juvenile
Date
Name of Officer Reporting
Officer Reviewing (If Applicable) I.D. Number
I.D. Number/Locator Code
BORES
SGT.COPEMAN 307
326
Arrest Number
20170709
DWLSR STATE OF FLORIDA
11 09A 1
1
2018
__/__/____
__/__/____
08/25/2017
__/__/____
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USA Rev. 01/21/2003
__/__/____
08/24/2017
Signature of Officer Reporting
Signature of Officer Reviewing
C O P
Y
1. Offense
2. Arrest
Juvenile
Warn/Dismiss
1. Original
2. Supplement
AD
M
Holmes Beach Police Department
DWLSR
FL0410400 20170709
2 1
BORES
SGT.COPEMAN 307
326
ON 08/24/2017 AT 20:50 HRS I WAS ON PATROL SITTING IN THE PARKIG LOT OF 3101 GULF DR. (MIKE NORMANS
REALITY) FACING THE INTERSECTIN OF GULF DR. AND EAST BAY DR. WHILE SITTING IN THE PARKING LOT I
OBSERVED A WHITE 4DR BUICKBEARING FLORIDA REGISTRATION (FL,708PMX) APPROACH THE INTERSECTION AND TURN
LEFT ONTO GULF DR. I HAD PRIOR KNOWLEDGE THAT THE WHITE BUICK WAS DRIVEN BY THE DEFENDANT WHO'S
DRIVER'S LICENSE HAS BEEN REVOKED ON 01/2007. I OBSERVED THE DEFENDANT DRIVING THE VEHICLE AS IT
TURNED LEFT ONTO GULF DR.I PULLED ONTO GULF DR TO GET BEHIND THE WHITE BUICK AS IT CONTINUED TO DRIVE
NORTH. I ACTIVATED MY EMERGENCY WARNING LIGHTS AND HE VEHICLE HAD A SLOW RESPONSE UNTIL FINALLY
STOPPING IN THE 3700 BLK OF GULF DR.
I APPROACHED THE VEHICLE ON THE DRIVER'S SIDE AND MADE CONTACT WITH THE DRIVER. I CONFIRMED THAT THE
DRIVER WAS DAVID E. VICKERS (V262165853790) THROUGH D.A.V.I.D. AND HBPD DISPATCH. AT THAT TIME I ASKED
MR. VICKERS TO STEP OUT OF THE VEHICLE AND PLACED HIM INTO CUSTODY AND PUT IN THE REAR OF MY PATROL
VEHICLE. DURING THE INVENTORY OF THE VEHICLE I LOCATED A BURNT MARIJUANA BLUNT CIGAR ON THE CENTER
CONSOLE. THE MARIJUANA CIGAR HAD THE TOTAL WEIGHT OF .1 GRAMS. MR. VICKERS ALSO HAD EIGHT PRIOR
CONVICTIONS OF DWLS/R AND WAS REVOKED ON 01/2007. I LATER TRANSPORTED MR. VICKERS TO MCSO JAIL.
THE FOLLOWING CITATIONS WERE ALSO ISSUED: A2H5XUE (DWLS/R, 3RD OR SUBSEQUENT).
NA
RR
AT
IVE
Original Date Reported
NARRATIVE CONTINUATION
Case Reference
Date of Supplement Agency ORI Number Agency Report Number
Case Status
Routed To Referred To
Related Report Number(s)
Unit
of
Page
Number ArrestedClearance Type
Exception Type 2. Arrest on Primary OffenseSecondary Offense Without Prosecution
3. Death of Offender4. V / W Refused to Cooperate
3.Unfounded
Page
Date
5. Prosecution Declined6. Juvenile/No Custody1.Extradition Declined
1.Arrest2.Exceptional
OBTS Number
Date Cleared
ByAssigned To
AD
MIN
IST
RA
TIV
E
A-AdultJ-Juvenile
Date
Name of Officer Reporting
Officer Reviewing (If Applicable) I.D. Number
I.D. Number/Locator CodeReport Contains
Arrest Number
__/__/____
08/24/2017
08/25/2017
__/__/____
__/__/____
USA Rev. 01/23/2003
Signature of Officer Reviewing
Signature of Officer Reporting
C O P
Y
504FW 2511/19/1991 150 BRO BLK L S
FL0410400
27
00
0254
01 01 02 00 00
GUTIERREZ
6011 FLORA TR 33572APOLLO BEACH
G362531919190
Holmes Beach Police Department
0254 0254 0330
20170710
FLORIDA
LYDIA KARINA
COV ALCOHOL
01
Thu
01 CITY OF HOLMES BEACH
5801 MARINA DRIVE HOLMES BEACH 3421
2 NN
V 5
2A
1 0 0 00 0000
FL
FL
MED MED
FL
WALKER
SGT.COPEMAN 307
6 6-3A 00000ACOV/ALCOHOL
___-_______
___-__-____
941 708-5804
___-_______
___ ___-____
___-_______
___ ___-____
34217GULF DRIVE HOLMES BEACH4000
0
5
1
312
1
COV ALCOHOL
N2 1
00. N/A
01. Gunshot
02. Stabbed
OFF/INC Indicator
EV
EN
TD
AT
AN
AR
RA
TIV
ES
US
PE
CT
CO
DE
SA
DM
A-AttemptedC-Committed
A-AttemptedC-Committed
Area
Type of Weapon
01. Residence Single02. Apartment/Condo03. Residence-Other04. Hotel/Motel
Time (mil)
GangRelated
Time Dispatched (mil)
Primary Offense Description
21. Employer
22. Landlord/Tenant
23. Acquaintance
99. Other Known
5. Ordinance9. Other
Zone
)
Agency Report Number
3. Misdemeanor4. Traffic Misdemeanor
OFF/INC# 1
Business Name/Area Identifier
District
NCIC/UCR Code
2. No
Location Type
V/W Code
# Victims
00. N/A01. Handgun
05. Knife/CuttingInstrument
06. Blunt Object
07. Hands/Fist/Feet08. Poison09. Explosives
10. Fire/Incendiary11. Threat/Intimidation12. Simulated Weapon
V - Victim
W - Witness
C - Reporting Person
O - Other
Race
N - N/A
M - Male
F - Female
U - Unknown
Residence Type
0. N/A
1. City
2. County
Extent of InjuryResidence Status
03. Laceration
04. Unconscious
05. Poss. Broken Bones
06. Poss. Internal Injury
Victim Relationship To Offender07. Loss of Teeth
08. Burns
09. Abrasions/Bruises
99. Other
06. Parent
07. Brother/Sister
08. Child
09. Step-Parent
10. Step-Child
11. In-Law
12. Other Family
13. Student
Residence Phone
Business Phone
Juvenille
Occupation
Height Weight Eye Color Hair Length Hair Style
Nickname/Street Name Place of Birth
Social Security Number
SCIC/NCIC
Employer/School
Teeth Speech/Voice Special Identifiers
Original DayReported
Date Time (mil) Time Arrived (mil) Time Completed (mil)
1. Felony2. Traffic Felony To
Time (mil)
(-
Type
15. Industrial/Mfg.16. Storage17. Gov't/Public Bldg.18. School/University19. Jail/Prison
20. Religious Bldg.21. Airport22. Bus/Rail Terminal23. Construction Site24. Other Structure
25. Parking Lot/Garage26. Highway/Roadway27. Park/Woodlands/Field28. Lake/Waterway29. Motor Vehicle
10. Dept/Discount Store11. Specialty Store12. Drug Store/Hospital13. Bank/Financial Inst.14. Commercial/Office Bldg.
Suspect Code
Incident Location (Street Number, Street, Apt,)
Scars/Marks/Tatoos (Location/Describe)
OFFENSE-INCIDENT REPORT
0. N/A1. Occupied
E-EscapeeM-Missing
From
Date of Supplement
- (
17. Friend
18. Neighbor
19. Sitter/Day Care
20. Employee
OFF/INC Indicator
OBTS Number (Arrested)Other I.D. NumberImmigration and Naturalization Number
Incident Type Incident: Day Date
2. Unoccupied3. Abandoned
05. Convenience Store06. Gas Station07. Liquor Sales08. Bar/Nightclub09. Supermarket
DateDay
0. N/A1. Yes
Forced Entry Occupancy
Statute Violation Number - Chapter, Section, SubDescriptionType
Hair Color
Facial HairBuildComplexion
Driver's License Number/State
Address
Code
Maiden Name
Name (Last, First, Middle)
13. Drugs88. Unknown99. Other
Grid
Victim Type0. N/A
1. Juvenile
2. L.E. Officer
3. Adult
4. Business
5. Government
6. Church
9. Other
Sex
I - American Indian
O - Oriental/Asian
U - Unknown
N - N/A
W - White
B - Black
3. Florida
4. Out-of-State
0. N/A
1. Full Year
2. Part Year
3. Non-Resident
0. None
1. Minor
2. Serious
3. Fatal
14. Teacher
15. Child of Boy/Girl
Friend
16. Boy/Girl Friend
03. Spouse
04. Ex-Spouse
05. Co-Habitant
00. N/A
01. Undetermined
02. Stranger
Injury Type
Clothing (Describe)
ZipStateCity
02. Rifle03. Shotgun04. Firearm
# Prem. Ent.
S-SuspectA-Arrestee
ZipCity
# OFF/INC. # Offenders # Veh. Stolen
1.#12.#2
3.Both
)
If V/W Code isV, W or C
Fill in this LineOFF/INC Indicator
V/W Code # Name (Last, First, Middle or Business) Residence Phone
Business Phone
Race Sex Injury Type(s) Relationship Ethnicity Will Victim prefer charge?
Synopsis of Involvement
V. Type
V/W Code # Name (Last, First, Middle or Business) Residence Phone
Business Phone
Race Sex Injury Type(s) Relationship Ethnicity Will Victim prefer charge?
Synopsis of Involvement
V. Type
Extent of InjuryRes. StatusRes. Type
ZipStateCity
Extent of InjuryRes. StatusRes. Type
ZipStateCity
VIC
TIM
/W
ITN
ES
SV
ICT
IM/W
ITN
ES
S
Dom. Violence
Dom. Violence
1.#12.#2
3.Both
1.#12.#2
3.Both
Date of Birth Age
Date of Birth Age
If V/W Code isV, W or C
Fill in this Line
Address (Street, Apt. Number)
Other Contact Info. (Time Available, Interpreter, etc.)
Address (Street, Apt. Number)
Other Contact Info. (Time Available, Interpreter, etc.)
Last Known Address (Street, Apt. Number)
OFF/INC# 2
R-Rec. MissingZ-other
Person/Unit Notified
Case Status
Time
Routed To Referred To
Related Report Number(s)
Unit
of
Page
Number ArrestedClearance Type
Exception Type2. Arrest on Primary Offense
Secondary Offense Without Prosecution3. Death of Offender4. V / W Refused to Cooperate
3.Unfounded
Page5. Prosecution Declined6. Juvenile/No Custody1.Extradition Declined
1.Arrest2.Exceptional
Jail Number
OBTS Number
Date Cleared
AD
MIN
IST
RA
TIV
E
A-AdultJ-Juvenile
Date
Name of Officer Reporting
Officer Reviewing (If Applicable) I.D. Number
I.D. Number/Locator Code
By DateAssigned To
30. Other Mobile99. Other
Susp.#
JuvenileWarn/Dismiss:
1. Original2. Supplement:
Juvenilein Report:
__/__/____
08/24/2017
08/25/2017
__/__/____
USA Rev. 01/23/2003
Thu Thu08/24/2017 08/24/2017
Sex Date of BirthRace Age
__/__/____
Yes No
YYeess NNoo
0
Signature of Officer Reporting
Signature of Officer Reviewing
C O P
Y
Holmes Beach Police Department1 1
WALKER
SGT.COPEMAN 307
312
ON 08/25/2017, AT 0253 HOURS, WHILE PATROLING 4000 GULF DRIVE, I OBSERVED A VEHICLE ILLEGALLY PARKED
IN A HANDICAPPED SPOT AFTER HOURS. USING NIGHTVISION I LOCATED TWO FEMALES HAVING RELATIONS ON THE
BEACH WHILE IN POSSESSION OF ALCOHOL. UPON SPEAKING WITH THE FEMALES (LYDIA GUTIERREZ) AND (SARAI
AGUILAR), THEY ADVISED THE ALCOHOL WAS THEIRS AND THAT THEIR VEHICLE WAS PARKED IN THE LOT. I ISSUED
EACH A CITATION FOR POSSESSION OF ALCOHOL ON THE BEACH AND ISSUED GUTIERREZ A PARKING CITATION FOR
PARKING IN A HANDICAP SPOT WITH NO PLACARD.
NA
RR
AT
IVE
Original Date Reported
NARRATIVE CONTINUATION
Case ReferenceAD
M
Date of Supplement Agency ORI Number
1. Offense
2. Arrest
Juvenile
Warn/Dismiss
1. Original
2. Supplement
Agency Report Number
Case Status
Routed To Referred To
Related Report Number(s)
Unit
of
Page
Number ArrestedClearance Type
Exception Type 2. Arrest on Primary OffenseSecondary Offense Without Prosecution
3. Death of Offender4. V / W Refused to Cooperate
3.Unfounded
Page
Date
5. Prosecution Declined6. Juvenile/No Custody1.Extradition Declined
1.Arrest2.Exceptional
OBTS Number
Date Cleared
ByAssigned To
AD
MIN
IST
RA
TIV
E
A-AdultJ-Juvenile
Date
Name of Officer Reporting
Officer Reviewing (If Applicable) I.D. Number
I.D. Number/Locator CodeReport Contains
Arrest Number
__/__/____
08/24/2017
08/25/2017
__/__/____
__/__/____
USA Rev. 01/23/2003
20170710FL0410400
Signature of Officer Reviewing
Signature of Officer Reporting
C O P
Y
2. No
FL0410400
26
00
0310
1 1 1 0 0
COPELAND
1244 JORDAN PARK 33712ST PETERSBURG
DRIVER DUNKIN DONUTS
C145012943641
603 275
Holmes Beach Police Department
0310 0310 0600
0310 0600
22
20170711
FLORIDA
AUSTIN LAMAR
WARRANT
1
Fri
Fri Fri
1 STATE OF FLORIDA
2 NN
MB
V 5
2A
BRO BLK
0 0 0 00 0000
FL
MED MUS
FL
BORES
SGT.COPEMAN 307
16 2800901AWARRANT
___-_______
___-__-____
___ ___-____
___-_______
___ ___-____
___-_______
___ ___-____
S
34217MANATEE AVE HOLMES BEACH700
0 0
9
1
326
1
SHORTS AND TEE SHIRT
N2 1
00. N/A
01. Gunshot
02. Stabbed
OFF/INC Indicator
EV
EN
TD
AT
AN
AR
RA
TIV
ES
US
PE
CT
CO
DE
SA
DM
A-AttemptedC-Committed
A-AttemptedC-Committed
Area
Type of Weapon
01. Residence Single02. Apartment/Condo03. Residence-Other04. Hotel/Motel
Time (mil)
GangRelated
Time Dispatched (mil)
Primary Offense Description
21. Employer
22. Landlord/Tenant
23. Acquaintance
99. Other Known
5. Ordinance9. Other
Zone
)
Agency Report Number
3. Misdemeanor4. Traffic Misdemeanor
OFF/INC# 1
Business Name/Area Identifier
District
NCIC/UCR Code
Location Type
V/W Code
# Victims
00. N/A01. Handgun
05. Knife/CuttingInstrument
06. Blunt Object
07. Hands/Fist/Feet08. Poison09. Explosives
10. Fire/Incendiary11. Threat/Intimidation12. Simulated Weapon
V - Victim
W - Witness
C - Reporting Person
O - Other
Race
N - N/A
M - Male
F - Female
U - Unknown
Residence Type
0. N/A
1. City
2. County
Extent of InjuryResidence Status
03. Laceration
04. Unconscious
05. Poss. Broken Bones
06. Poss. Internal Injury
Victim Relationship To Offender07. Loss of Teeth
08. Burns
09. Abrasions/Bruises
99. Other
06. Parent
07. Brother/Sister
08. Child
09. Step-Parent
10. Step-Child
11. In-Law
12. Other Family
13. Student
Residence Phone
Business Phone
Juvenille
Occupation
Sex Date of Birth Height Weight Eye Color Hair Length Hair Style
Nickname/Street Name Place of Birth
Social Security Number
SCIC/NCIC
Employer/School
Teeth Speech/Voice Special Identifiers
Original DayReported
Date Time (mil) Time Arrived (mil) Time Completed (mil)
1. Felony2. Traffic Felony To
Time (mil)
(-
Type
15. Industrial/Mfg.16. Storage17. Gov't/Public Bldg.18. School/University19. Jail/Prison
20. Religious Bldg.21. Airport22. Bus/Rail Terminal23. Construction Site24. Other Structure
25. Parking Lot/Garage26. Highway/Roadway27. Park/Woodlands/Field28. Lake/Waterway29. Motor Vehicle
10. Dept/Discount Store11. Specialty Store12. Drug Store/Hospital13. Bank/Financial Inst.14. Commercial/Office Bldg.
Suspect Code
Incident Location (Street Number, Street, Apt,)
Scars/Marks/Tatoos (Location/Describe)
OFFENSE-INCIDENT REPORT
0. N/A1. Occupied
E-EscapeeM-Missing
From
Date of Supplement
- (
17. Friend
18. Neighbor
19. Sitter/Day Care
20. Employee
OFF/INC Indicator
OBTS Number (Arrested)Other I.D. NumberImmigration and Naturalization Number
Incident Type Incident: Day Date
2. Unoccupied3. Abandoned
05. Convenience Store06. Gas Station07. Liquor Sales08. Bar/Nightclub09. Supermarket
DateDay
0. N/A1. Yes
Forced Entry Occupancy
Statute Violation Number - Chapter, Section, SubDescriptionType
Hair ColorRace
Facial HairBuildComplexion
Driver's License Number/State
Address
Code
Maiden Name
Name (Last, First, Middle)
13. Drugs88. Unknown99. Other
Grid
Victim Type0. N/A
1. Juvenile
2. L.E. Officer
3. Adult
4. Business
5. Government
6. Church
9. Other
Sex
I - American Indian
O - Oriental/Asian
U - Unknown
N - N/A
W - White
B - Black
3. Florida
4. Out-of-State
0. N/A
1. Full Year
2. Part Year
3. Non-Resident
0. None
1. Minor
2. Serious
3. Fatal
14. Teacher
15. Child of Boy/Girl
Friend
16. Boy/Girl Friend
03. Spouse
04. Ex-Spouse
05. Co-Habitant
00. N/A
01. Undetermined
02. Stranger
Injury Type
Clothing (Describe)
ZipStateCity
02. Rifle03. Shotgun04. Firearm
# Prem. Ent.
S-SuspectA-Arrestee
ZipCity
# OFF/INC. # Offenders # Veh. Stolen
1.#12.#2
3.Both
)
If V/W Code isV, W or C
Fill in this LineOFF/INC Indicator
V/W Code # Name (Last, First, Middle or Business) Residence Phone
Business Phone
Race Sex Injury Type(s) Relationship Ethnicity Will Victim prefer charge?
Synopsis of Involvement
V. Type
V/W Code # Name (Last, First, Middle or Business) Residence Phone
Business Phone
Race Sex Injury Type(s) Relationship Ethnicity Will Victim prefer charge?
Synopsis of Involvement
V. Type
Extent of InjuryRes. StatusRes. Type
ZipStateCity
Extent of InjuryRes. StatusRes. Type
ZipStateCity
VIC
TIM
/W
ITN
ES
SV
ICT
IM/W
ITN
ES
S
Dom. Violence
Dom. Violence
1.#12.#2
3.Both
1.#12.#2
3.Both
Date of Birth Age
Date of Birth Age
If V/W Code isV, W or C
Fill in this Line
Address (Street, Apt. Number)
Other Contact Info. (Time Available, Interpreter, etc.)
Address (Street, Apt. Number)
Other Contact Info. (Time Available, Interpreter, etc.)
Last Known Address (Street, Apt. Number)
OFF/INC# 2
R-Rec. MissingZ-other
Age
Person/Unit Notified
Case Status
Time
Routed To Referred To
Related Report Number(s)
Unit
of
Page
Number ArrestedClearance Type
Exception Type2. Arrest on Primary Offense
Secondary Offense Without Prosecution3. Death of Offender4. V / W Refused to Cooperate
3.Unfounded
Page5. Prosecution Declined6. Juvenile/No Custody1.Extradition Declined
1.Arrest2.Exceptional
Jail Number
OBTS Number
Date Cleared
AD
MIN
IST
RA
TIV
E
A-AdultJ-Juvenile
Date
Name of Officer Reporting
Officer Reviewing (If Applicable) I.D. Number
I.D. Number/Locator Code
By DateAssigned To
30. Other Mobile99. Other
Susp.#
JuvenileWarn/Dismiss:
1. Original2. Supplement:
Juvenilein Report:
08/25/2017
08/25/2017 08/25/2017
__/__/____
08/25/2017
__/__/____
__/__/____
USA Rev. 01/23/2003
10/04/1994
Signature of Officer Reviewing
Signature of Officer Reporting
SEE NARATIVE PAGE..
Yes No
YYeess NNoo
C O P
Y
Holmes Beach Police Department 20170711
N 1
___-_______
___-__-____
___ ___-____
___-_______
___ ___-____
___-_______
___ ___-____
___-__-____
___-_______
___ ___-____
326
SGT.COPEMAN
BORES
307
WARRANT STATE OF FLORIDA
CO
DE
SA
DM
Juvenilein Report:
Date of Supplement
Primary Offense Description
Victim Type Race
Victim Relationship To Offender
Agency Report Number
Residence Type Residence Status4. Business5. Government6. Church9. Other
SexN-N/AM-MaleF-FemaleU-Unknown
0. N/A1. City2. County
3. Florida4. Out-of-State
0. N/A1. Full Year2. Part Year3. Non-Resident
0. None1. Minor2. Serious3. Fatal
07. Loss of Teeth08. Burns09. Abrasions/Bruises99. Other
00. N/A01. Undetermined02. Stranger
03. Spouse04. Ex-Spouse05. Co-Habitant
06. Parent07. Brother/Sister08. Child09. Step-Parent
14. Teacher15. Child of Boy/Girl Friend16. Boy/Girl Friend
17. Friend18. Neighbor19. Sitter/Day Care20. Employee
21. Employer22. Landlord/Tenant23. Acquaintance99. Other Known
PERSON(S) REPORT
Injury Type
00. N/A01. Gunshot02. Stabbed
Original Date
1. Original2. Supplement:
0. N/A1. Juvenile2. L.E. Officer3. Adult
N-N/AW-WhiteB-Black
I-American IndianO-Oriental/AsianU-Unknown
03. Laceration04. Unconscious05. Poss. Broken Bones06. Poss. Internal Injury
10. Step-Child11. In-Law12. Other Family13. Student
Victim #1 Name (Last, First, Middle)
V/W Code
V - VictimW - WitnessC - Reporting Person
O - Other
Will Victim prefer charge?
Will Victim prefer charge?
Extent of Injury
SU
SP
EC
TO
RM
ISS
ING
PE
RS
ON
S
If V/W Code isV, W or C
Fill in this LineOFF/INC Indicator
OFF/INC Indicator V/W Code # Name (Last, First, Middle or Business) Residence Phone
Business Phone
Race Sex Injury Type(s) Relationship Ethnicity
Synopsis of Involvement
V. Type
V/W Code # Name (Last, First, Middle or Business) Residence Phone
Business Phone
Race Sex Relationship Ethnicity
Synopsis of Involvement
Extent of InjuryRes. StatusRes. Type
ZipStateCity
Extent of InjuryRes. StatusRes. Type
ZipStateCity
VIC
TIM
/W
ITN
ES
SV
ICT
IM/W
ITN
ES
S
Dom. Violence
Dom. Violence
1.#12.#2
3.Both
1.#12.#2 3.Both
Date of Birth Age
Date of Birth Age
If V/W Code isV, W or C
Fill in this Line
Address (Street, Apt. Number)
Address (Street, Apt. Number)
Other Contact Info. (Time Available, Interpreter, etc.)
Other Contact Info. (Time Available, Interpreter, etc.)
SU
SP
EC
TO
RM
ISS
ING
PE
RS
ON
S
Hair Color
Suspect Code Code
Maiden Name
Occupation
Driver's License State/Number
Employer/School
Immigration and Naturalization Number Other ID. Number
Address
Place of Birth Residence Phone
Business Phone
Social Security Number
OBTS Number
Date of Birth or Age Height
Complexion Facial Hair Teeth Speech/Voice Special Identifiers
Eye Color Hair Length Hair Style
Name (Last, First, Middle)
Clothing (Describe)
Last Known Address (Street, Apt. Number)
OFF/INC Indicator
1.#12.#2
Sex
Nickname/Street Name
SCIC/NCIC
WeightRace
Juvenile
Build
3.Both
City
Maiden Name
Occupation
Driver's License State/Number
Employer/School
Immigration and Naturalization Number Other ID. Number
Address
Place of Birth Residence Phone
Business Phone
Social Security Number
OBTS Number
Date of Birth Height
Complexion Facial Hair Teeth Speech/Voice Special Identifiers
Eye Color Hair Length Hair Style
State Zip
Clothing (Describe)
Last Known Address (Street, Apt. Number)
Sex
Nickname/Street Name
SCIC/NCIC
Hair ColorWeightRace
Build
Code Name (Last, First, Middle)OFF/INC Indicator
1.#12.#2
Juvenile
3.Both
Susp. #
E-EscapeeM-Missing
Suspect Code
S-SuspectA-Arrestee
R-Rec. MissingZ-other
Susp. #
Age
V. Type
E-EscapeeM-Missing
S-SuspectA-Arrestee
R-Rec. MissingZ-other
Injury Type(s)
ZipStateCity
Scars/Marks/Tatoos (Location/Describe)
Scars/Marks/Tatoos (Location/Describe)
MIS
SIN
GP
ER
SO
N/
RU
NA
WA
Y 7. VoluntaryAdult
8. Unknown
1. Yes2. No8. Unknown
Incident Type
1. Runaway2. Parental3. Involuntary
Foul Play Suspected ?
1. Yes2. No
Missing Before ?
1. Yes2. No8. Unknown
1. Yes2. No8. Unknown
1. Yes2. No8. Unknown
MCIC Form Provided ?
4. Disabled5. Endangered6. Disaster Victim
Fingerprints Available? Dental Record Available
1. Yes2. No
Photo Available?
Date Last Seen Time Last Seen Accompanied By
Property Carried
Probable Destination
Medication Required/Type
ID. Type/Number
Recovery Information7. Deceased9. Other
Doctor/Dentist (Name, Phone Number)
Transportation Mode
Location Last Seen (Address, City, St.)
5. Law Enforcement Custody6. Returned to Parent
3. Hospitalized4. HRS Custody
2. Located-Not Returned
0. N/A1. Voluntary
Name/Address
ID. Type/Number
Mental/Physical Condition
AD
MIN
IST
RA
TIV
E
ID. Number(s)/Locator code Unit
DateID. Number Routed To Referred To Assigned To
Officer(s) Reporting Date
By
of
PagePage
Officer Reviewing (If Applicable)
Signature of Officer Reporting
__/__/____
08/25/2017
__/__/____
08/25/2017
USA Rev. 01/23/2003
__/__/____
Signature of Officer Reviewing
YYeess NNoo
YYeess NNoo
C O P
Y
Type
Type
Type
Code Person
Code Person
Code Person
Code Person
Code Person
Holmes Beach Police Department20170711
0.00
0.00
326
SGT.COPEMAN
BORES
307
1
WARRANT STATE OF FLORIDA
TH
EF
TA
DM
A. Auto Accessory/PartsB. BicycleC. Camera/Photo EquipmentD. Drug
T. TV/Video/VCRU. Currency/NegotiableV. Credit Card/Non-NegotiableW. Boat MotorX. Structure
Property TypeO. Office EquipmentP. Art/CollectionQ. Computer EquipmentR. Radio/StereoS. Sports Equipment
E. Equipment/Tool.F. Food/Liquor/ConsumableG. GunH. Household Appliance/GoodsI. Plant/Citrus
J. Jewelry/Precious MetalK. Clothing/FurL. LivestockM. Musical InstrumentN. Construction Machinery
Date of Supplement
Original Date Reported Primary Offense Description Victim #1 Name (Last, First, Middle)
Agency Report Number
1. Original2. SupplementPROPERTY REPORT
Y. Farm EquipmentZ. Miscellaneous
PR
OP
.D
ET
AIL
/N
AR
R.
CO
DE
S
09. From Vehicle10. Extortion
Theft Type Codes
04. Pocket Picking05. Purse Snatching
06. Embezzlement07. From Coin Oper. Machine
08. From PublicAccess Building
11. By Computer12. Fraud
99. Other00. N/A01. Burglary
02. Robbery03. Shoplifting
Theft Type
A - ArresteeO - Other
1. Stolen2. Recovered
V - VictimS - Suspect
5. Lost6. Found
Person Codes Status Codes
3. Stolen and Recovered4. Recovered for Other Jurisdiction
2. Criminal Mischief3. During other Offense
7. Safekeeping8. Evidence/Seized
9. Other9. Other
Damage Codes
0. N/A1. Arson
PR
OP
ER
TY
Serial Number
NameItem # Status Damage Property Type Quantity Brand Model Name/Number
Owner Applied Number Description (Size, Color, Caliber, Barrel Length, Etc. )
Value Value Recovered Date Recovered SCIC/NCIC
PropertyStolen
PropertyRecovered
Change in PropertyStolen Value
Change in PropertyRecovered Value
Activity Type Unit
Activity Description Quantity Unit
P. PossessS. SellB. BuyT. Traffic
R. SmuggleD. DeliverE. UseK. Dispense/Distribute
M. Manufacture/Produce/CultivateZ. Other
A. AmphetamineB. BarbiturateC. CocaineE. Heroin
H. HallucinogenM. MarijuanaO. Opium/DerivativeP. Paraphernalia/Equipment
S. SyntheticU. UnknownZ. Other
1. Gram2. Milligram3. Kilogram4. Ounce
5. Pound6. Ton7. Liter8. Milliliter
Estimated Street Value
TO
TA
LS
CO
DE
SD
RU
GS
PR
OP
ER
TY
Serial Number
NameItem # Status Damage Property Type Quantity BrandModel Name/Number
Owner Applied Number Description (Size, Color, Caliber, Barrel Length, Etc. )
Value Value Recovered Date Recovered SCIC/NCIC
PR
OP
ER
TY
Serial Number
NameItem # Status Damage Property Type Quantity Brand Model Name/Number
Owner Applied Number Description (Size, Color, Caliber, Barrel Length, Etc. )
Value Value Recovered Date Recovered SCIC/NCIC
PR
OP
ER
TY
Serial Number
NameItem # Status Damage Property Type Quantity Brand Model Name/Number
Owner Applied Number Description (Size, Color, Caliber, Barrel Length, Etc. )
Value Value Recovered Date Recovered SCIC/NCIC
PR
OP
ER
TY
Serial Number
NameItem # Status Damage Property Type Quantity Brand Model Name/Number
Owner Applied Number Description (Size, Color, Caliber, Barrel Length, Etc. )
Value Value Recovered Date Recovered SCIC/NCIC
Activity Description Quantity Unit Estimated Street Value
Activity Description Quantity Unit Estimated Street Value
AD
MIN
IST
RA
TIV
E
ID. Number(s)/Locator code Unit
DateID. Number Routed To Referred To Assigned To
Officer(s) Reporting Date
By
of
PagePage
Officer Reviewing (If Applicable)
Signature of Officer Reviewing
Signature of Officer Reporting
9. Dose Unit/Item
__/__/____
08/25/2017
__/__/____
__/__/____
__/__/____
__/__/____
__/__/____
08/25/2017
__/__/____
USA Rev. 01/23/2003
C O P
Y
AD
M
1100.. OOtthheerr -- SSppeecc..66.. TTrraannss..
77.. EEnnggiinnee PPaarrttss
1. Key
11.. KKeeyy
3. Hot Wire
6. Trans.
7. Engine Parts
8. Major Body Parts
VE
HIC
LE
/V
ES
SE
L1. Original2. Supplement
Date of Supplement
Reg. State
Date Recovered
LengthVessel Name
StyleModelStatusPerson #
1. Local / Local
2. Local / Other
3. Other / Local
Tag Type
Primary Offense Description Victim #1 Name (Last, First, Middle)
Person Code Status Code Damage Code Type Recovery Location Recovery Code
Stolen / Recovered
Holmes Beach Police Department
1. Stolen2. Recovered3. Stolen and
Recovered4. Suspicious
5. Impounded6. Abandoned7. Fail Return8. Seized9. Other
0. N / A1. Arson2. Criminal Mischief3. During Other Offense
1. Auto2. Truck / Van3. Motorcycle4. Camper / RV5. Bus
6. Trailer7. Boat8. Aircraft9. Other
VEHICLE REPORT
Original Date Reported
Agency Report Number
Description (Identifying Characteristics, Noticeable Damage, Interior Color, etc)
Tag Reg./Doc. # Reg. Year Decal Number
VIN/Hull/FAA Estimated Value
Propulsion
Insurance Company Lien HolderCondition
Hull Material Boat Type
Recovery Address/Geographic Indicator
Recovery Loc. Recovery Code Original Reporting Agency Report Number Reason/Authority
SCIC/NCIC Location of Original Theft
Value Recovered
1. Window Closed
ICTH04
1HTMMMML3JH679270
2. Locked 3. Keys in Ignition
WHITE
Color (Top/Bottom)
Towed By
Components Stripped
0. N/A 5. Interior 9. Tag/Decal Stolen
10. Other - Spec.0. N/A 8. Unk.2. Tow Truck 4. Steering
5. Ignition 1. VIN Plt.
4. Battery
Person Code Damage Type Year Make
2018 INTL TRK BOX
Storage Location
V- VictimS- SuspectA- ArresteeO- Other
5. Park / Playground6. Shopping Mall7. Woods8. Water9. Other
1. Family Residence2. Apt. Complex3. Housing Project4. Commercial /
Industrial
4. Stripped / TheftFrom
9. Other
CO
DE
SV
EH
ICL
E/V
ES
SE
LV
EH
ICL
EIN
V./N
AR
RA
TIV
E
Person Code Person # Status Damage StyleModelType Year Make
Reg. State Tag TypeTag Reg./Doc. # Reg. Year Decal Number
VIN/Hull/FAA Estimated Value
Insurance Company Lien HolderCondition
1. Window Closed1. Window Closed 2. Locked2. Locked 3. Keys in Ignition3. Keys in Ignition
Description (Identifying Characteristics, Noticeable Damage, Interior Color, etc)Color (Top/Bottom)
LengthVessel Name PropulsionHull Material Boat Type
Date RecoveredRecovery Address/Geographic Indicator Value Recovered
Recovery Loc. Recovery Code Original Reporting Agency Report Number Reason/Authority
Methodof Theft
00.. NN//AA 88.. UUnnkk..22.. TTooww TTrruucckk
33.. HHoott WWiirree
44.. SStteeeerriinngg
55.. IIggnniittiioonn
Components Stripped
00.. NN//AA 55.. IInntteerriioorr
88.. MMaajjoorr BBooddyy PPaarrttss
99.. TTaagg//DDeeccaall SSttoolleenn11.. VVIINN PPlltt..
44.. BBaatttteerryy
Location of Original TheftTowed By Storage Location SCIC/NCIC
Vehicle #
HoldY - YesN - No
HoldY - YesN - No
Vehicle #
Methodof Theft
2. Tires/Wheels
3. Radio/CB
22.. TTiirreess//WWhheeeellss
33.. RRaaddiioo//CCBB
FL
Case Status
Routed To Referred To
Unit
of
Page
Number ArrestedClearance Type
Exception Type 2. Arrest on Primary OffenseSecondary Offense Without Prosecution
3. Death of Offender4. V / W Refused to Cooperate
3.Unfounded
Page
Date
5. Prosecution Declined6. Juvenile Custody1.Extradition Declined
1.Arrest2.Exceptional
OBTS Number
Date Cleared
ByAssigned To
AD
MIN
IST
RA
TIV
E
A-AdultJ-Juvenile
Date
Name of Officer Reporting
Officer Reviewing (If Applicable) I.D. Number
I.D. Number/Locator Code
BORES
SGT.COPEMAN 307
326
Arrest Number
20170711
WARRANT STATE OF FLORIDA
11 09A 2
1
2017
__/__/____
__/__/____
08/25/2017
__/__/____
__/__/____
USA Rev. 01/21/2003
__/__/____
08/25/2017
Signature of Officer Reporting
Signature of Officer Reviewing
C O P
Y
1. Offense
2. Arrest
Juvenile
Warn/Dismiss
1. Original
2. Supplement
AD
M
Holmes Beach Police DepartmentFL0410400 20170711
1 1
BORES
SGT.COPEMAN 307
326
NA
RR
AT
IVE
Original Date Reported
NARRATIVE CONTINUATION
Case Reference
Date of Supplement Agency ORI Number Agency Report Number
Case Status
Routed To Referred To
Related Report Number(s)
Unit
of
Page
Number ArrestedClearance Type
Exception Type 2. Arrest on Primary OffenseSecondary Offense Without Prosecution
3. Death of Offender4. V / W Refused to Cooperate
3.Unfounded
Page
Date
5. Prosecution Declined6. Juvenile/No Custody1.Extradition Declined
1.Arrest2.Exceptional
OBTS Number
Date Cleared
ByAssigned To
AD
MIN
IST
RA
TIV
E
A-AdultJ-Juvenile
Date
Name of Officer Reporting
Officer Reviewing (If Applicable) I.D. Number
I.D. Number/Locator CodeReport Contains
Arrest Number
__/__/____
08/25/2017
08/25/2017
__/__/____
__/__/____
USA Rev. 01/23/2003
Signature of Officer Reviewing
Signature of Officer Reporting
C O P
Y
3110/19/1985
FL0410400
03
00
1403
1 1 1 00 00
VICKERS
5610 SOLITAIRE PALM WAY 33572APOLLO BEACH
V262165853790
606
Holmes Beach Police Department
1403 1403 1440
20170716
DAVID EARL
THEFT
01
Sat
Mon Sat
01 WOLFE
206 PEACOCK LN HOLMES BEACH 34217
29
MELISA SUSAN
2 FW
MW
V 3
2S
BLU BLD
1 1 0 00 1600
FL
FL
LT MED B
FL
PATROL
J. PIERCE
SGT.K.POWERS 320
DET
014 1 230G812CTHEFT/fOTHERS
___-_______
___-__-____
941 822-3986
___-_______
___ ___-____
___-_______
___ ___-____
X
34217PEACOCK LN HOLMES BEACH206
2 0
1
1
309
1
LAPTOP AND STEREO OWNER
TATTOOS
N2 1
00. N/A
01. Gunshot
02. Stabbed
OFF/INC Indicator
EV
EN
TD
AT
AN
AR
RA
TIV
ES
US
PE
CT
CO
DE
SA
DM
A-AttemptedC-Committed
A-AttemptedC-Committed
Area
Type of Weapon
01. Residence Single02. Apartment/Condo03. Residence-Other04. Hotel/Motel
Time (mil)
GangRelated
Time Dispatched (mil)
Primary Offense Description
21. Employer
22. Landlord/Tenant
23. Acquaintance
99. Other Known
5. Ordinance9. Other
Zone
)
Agency Report Number
3. Misdemeanor4. Traffic Misdemeanor
OFF/INC# 1
Business Name/Area Identifier
District
NCIC/UCR Code
2. No
Location Type
V/W Code
# Victims
00. N/A01. Handgun
05. Knife/CuttingInstrument
06. Blunt Object
07. Hands/Fist/Feet08. Poison09. Explosives
10. Fire/Incendiary11. Threat/Intimidation12. Simulated Weapon
V - Victim
W - Witness
C - Reporting Person
O - Other
Race
N - N/A
M - Male
F - Female
U - Unknown
Residence Type
0. N/A
1. City
2. County
Extent of InjuryResidence Status
03. Laceration
04. Unconscious
05. Poss. Broken Bones
06. Poss. Internal Injury
Victim Relationship To Offender07. Loss of Teeth
08. Burns
09. Abrasions/Bruises
99. Other
06. Parent
07. Brother/Sister
08. Child
09. Step-Parent
10. Step-Child
11. In-Law
12. Other Family
13. Student
Residence Phone
Business Phone
Juvenille
Occupation
Sex Date of Birth Height Weight Eye Color Hair Length Hair Style
Nickname/Street Name Place of Birth
Social Security Number
SCIC/NCIC
Employer/School
Teeth Speech/Voice Special Identifiers
Original DayReported
Date Time (mil) Time Arrived (mil) Time Completed (mil)
1. Felony2. Traffic Felony To
Time (mil)
(-
Type
15. Industrial/Mfg.16. Storage17. Gov't/Public Bldg.18. School/University19. Jail/Prison
20. Religious Bldg.21. Airport22. Bus/Rail Terminal23. Construction Site24. Other Structure
25. Parking Lot/Garage26. Highway/Roadway27. Park/Woodlands/Field28. Lake/Waterway29. Motor Vehicle
10. Dept/Discount Store11. Specialty Store12. Drug Store/Hospital13. Bank/Financial Inst.14. Commercial/Office Bldg.
Suspect Code
Incident Location (Street Number, Street, Apt,)
Scars/Marks/Tatoos (Location/Describe)
OFFENSE-INCIDENT REPORT
0. N/A1. Occupied
E-EscapeeM-Missing
From
Date of Supplement
- (
17. Friend
18. Neighbor
19. Sitter/Day Care
20. Employee
OFF/INC Indicator
OBTS Number (Arrested)Other I.D. NumberImmigration and Naturalization Number
Incident Type Incident: Day Date
2. Unoccupied3. Abandoned
05. Convenience Store06. Gas Station07. Liquor Sales08. Bar/Nightclub09. Supermarket
DateDay
0. N/A1. Yes
Forced Entry Occupancy
Statute Violation Number - Chapter, Section, SubDescriptionType
Hair ColorRace
Facial HairBuildComplexion
Driver's License Number/State
Address
Code
Maiden Name
Name (Last, First, Middle)
13. Drugs88. Unknown99. Other
Grid
Victim Type0. N/A
1. Juvenile
2. L.E. Officer
3. Adult
4. Business
5. Government
6. Church
9. Other
Sex
I - American Indian
O - Oriental/Asian
U - Unknown
N - N/A
W - White
B - Black
3. Florida
4. Out-of-State
0. N/A
1. Full Year
2. Part Year
3. Non-Resident
0. None
1. Minor
2. Serious
3. Fatal
14. Teacher
15. Child of Boy/Girl
Friend
16. Boy/Girl Friend
03. Spouse
04. Ex-Spouse
05. Co-Habitant
00. N/A
01. Undetermined
02. Stranger
Injury Type
Clothing (Describe)
ZipStateCity
02. Rifle03. Shotgun04. Firearm
# Prem. Ent.
S-SuspectA-Arrestee
ZipCity
# OFF/INC. # Offenders # Veh. Stolen
1.#12.#2
3.Both
)
If V/W Code isV, W or C
Fill in this LineOFF/INC Indicator
V/W Code # Name (Last, First, Middle or Business) Residence Phone
Business Phone
Race Sex Injury Type(s) Relationship Ethnicity Will Victim prefer charge?
Synopsis of Involvement
V. Type
V/W Code # Name (Last, First, Middle or Business) Residence Phone
Business Phone
Race Sex Injury Type(s) Relationship Ethnicity Will Victim prefer charge?
Synopsis of Involvement
V. Type
Extent of InjuryRes. StatusRes. Type
ZipStateCity
Extent of InjuryRes. StatusRes. Type
ZipStateCity
VIC
TIM
/W
ITN
ES
SV
ICT
IM/W
ITN
ES
S
Dom. Violence
Dom. Violence
1.#12.#2
3.Both
1.#12.#2
3.Both
Date of Birth Age
Date of Birth Age
If V/W Code isV, W or C
Fill in this Line
Address (Street, Apt. Number)
Other Contact Info. (Time Available, Interpreter, etc.)
Address (Street, Apt. Number)
Other Contact Info. (Time Available, Interpreter, etc.)
Last Known Address (Street, Apt. Number)
OFF/INC# 2
R-Rec. MissingZ-other
Age
Person/Unit Notified
Case Status
Time
Routed To Referred To
Related Report Number(s)
Unit
of
Page
Number ArrestedClearance Type
Exception Type2. Arrest on Primary Offense
Secondary Offense Without Prosecution3. Death of Offender4. V / W Refused to Cooperate
3.Unfounded
Page5. Prosecution Declined6. Juvenile/No Custody1.Extradition Declined
1.Arrest2.Exceptional
Jail Number
OBTS Number
Date Cleared
AD
MIN
IST
RA
TIV
E
A-AdultJ-Juvenile
Date
Name of Officer Reporting
Officer Reviewing (If Applicable) I.D. Number
I.D. Number/Locator Code
By DateAssigned To
30. Other Mobile99. Other
Susp.#
JuvenileWarn/Dismiss:
1. Original2. Supplement:
Juvenilein Report:
__/__/____
08/26/2017
08/21/2017 08/26/2017
__/__/____
08/27/2017
__/__/____
USA Rev. 01/21/2003
12/26/1987
Signature of Officer Reporting
Signature of Officer Reviewing
Yes No
YYeess NNoo
C O P
Y
Type
Type
Type
Holmes Beach Police Department20170716
45126AHQF5W
1
APPLE MACBOOK
APPLE1 LAPTOP01 MACBOOK
170X1164
1
JVC
JVC1 STEREO01 KD-R775S
0
V 0
Q
R
1,499.00
300.00
1
1
00
APPLE MACBOOKJVC STEREO
1,799.00
0.00
PATROL
DET
309
SGT.K.POWERS
J. PIERCE
320
1
THEFT WOLFE MELISA SUSAN
V
TH
EF
TA
DM
A. Auto Accessory/PartsB. BicycleC. Camera/Photo EquipmentD. Drug
T. TV/Video/VCRU. Currency/NegotiableV. Credit Card/Non-NegotiableW. Boat MotorX. Structure
Property TypeO. Office EquipmentP. Art/CollectionQ. Computer EquipmentR. Radio/StereoS. Sports Equipment
E. Equipment/Tool.F. Food/Liquor/ConsumableG. GunH. Household Appliance/GoodsI. Plant/Citrus
J. Jewelry/Precious MetalK. Clothing/FurL. LivestockM. Musical InstrumentN. Construction Machinery
Date of Supplement
Original Date Reported Primary Offense Description Victim #1 Name (Last, First, Middle)
Agency Report Number
1. Original2. SupplementPROPERTY REPORT
Y. Farm EquipmentZ. Miscellaneous
PR
OP
.D
ET
AIL
/N
AR
R.
CO
DE
S
09. From Vehicle10. Extortion
Theft Type Codes
04. Pocket Picking05. Purse Snatching
06. Embezzlement07. From Coin Oper. Machine
08. From PublicAccess Building
11. By Computer12. Fraud
99. Other00. N/A01. Burglary
02. Robbery03. Shoplifting
Theft Type
A - ArresteeO - Other
1. Stolen2. Recovered
V - VictimS - Suspect
5. Lost6. Found
Person Codes Status Codes
3. Stolen and Recovered4. Recovered for Other Jurisdiction
2. Criminal Mischief3. During other Offense
7. Safekeeping8. Evidence/Seized
9. Other9. Other
Damage Codes
0. N/A1. Arson
PR
OP
ER
TY
Serial Number
NameItem #Code Person Status Damage Property Type Quantity Brand Model Name/Number
Owner Applied Number Description (Size, Color, Caliber, Barrel Length, Etc. )
Value Value Recovered Date Recovered SCIC/NCIC
PropertyStolen
PropertyRecovered
Change in PropertyStolen Value
Change in PropertyRecovered Value
Activity Type Unit
Activity Description Quantity Unit
P. PossessS. SellB. BuyT. Traffic
R. SmuggleD. DeliverE. UseK. Dispense/Distribute
M. Manufacture/Produce/CultivateZ. Other
A. AmphetamineB. BarbiturateC. CocaineE. Heroin
H. HallucinogenM. MarijuanaO. Opium/DerivativeP. Paraphernalia/Equipment
S. SyntheticU. UnknownZ. Other
1. Gram2. Milligram3. Kilogram4. Ounce
5. Pound6. Ton7. Liter8. Milliliter
Estimated Street Value
TO
TA
LS
CO
DE
SD
RU
GS
PR
OP
ER
TY
Serial Number
NameItem #Code Person Status Damage Property Type Quantity Brand Model Name/Number
Owner Applied Number Description (Size, Color, Caliber, Barrel Length, Etc. )
Value Value Recovered Date Recovered SCIC/NCIC
PR
OP
ER
TY
Serial Number
NameItem #Code Person Status Damage Property Type Quantity Brand Model Name/Number
Owner Applied Number Description (Size, Color, Caliber, Barrel Length, Etc. )
Value Value Recovered Date Recovered SCIC/NCIC
PR
OP
ER
TY
Serial Number
NameItem #Code Person Status Damage Property Type Quantity Brand Model Name/Number
Owner Applied Number Description (Size, Color, Caliber, Barrel Length, Etc. )
Value Value Recovered Date Recovered SCIC/NCIC
PR
OP
ER
TY
Serial Number
NameItem #Code Person Status Damage Property Type Quantity Brand Model Name/Number
Owner Applied Number Description (Size, Color, Caliber, Barrel Length, Etc. )
Value Value Recovered Date Recovered SCIC/NCIC
Activity Description Quantity Unit Estimated Street Value
Activity Description Quantity Unit Estimated Street Value
AD
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ID. Number(s)/Locator code Unit
DateID. Number Routed To Referred To Assigned To
Officer(s) Reporting Date
By
of
PagePage
Officer Reviewing (If Applicable)
Signature of Officer Reviewing
Signature of Officer Reporting
9. Dose Unit/Item
__/__/____
08/26/2017
__/__/____
__/__/____
__/__/____
__/__/____
__/__/____
08/27/2017
__/__/____
USA Rev. 01/21/2003
C O P
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Holmes Beach Police Department
THEFT
FL0410400 20170716
1 1
DET
PATROL
J. PIERCE
SGT.K.POWERS 320
309
ON 08-27-17 I RESPONDED TO 5801 MARINA DR TO TAKE A THEFT REPORT FROM THE VICTIM (MELISA WOLFE). SHE
ADVISED THAT SHE HAD BEEN AT THE HOSPITAL TENDING TO HER CHILD FOR A FEW DAYS AND WHEN SHE RETURNED ON
08-25-17 SHE OBSERVED ITEMS MISSING FROM HER RESIDENCE AND HER VEHICLE. SHE STATED THAT SHE CONFRONTED
HER BOYFRIEND (DAVID VICKERS)OVER THE INCIDENT AFTER FINDING A WATER BOTTLE WITH A PAWN LOGO ON IT
INSIDE HER VEHICLE. HE THEN ADMITTED TO HER THAT HE HAD PAWNED HER SPEAKERS AND HER CAR STEREO. WOLFE
TOLD HIM THAT HE DID NOT HAVE PERMISSION TO PAWN ANY OF HER BELONGINGS. SHE ALSO OBSERVED HER LAPTOP
MISSING AND WAS UNABLE TO FIND IT IN HER RESIDENCE WHERE SHE LEFT IT. AFTER FINDING THE WATER BOTTLE
IN HER CAR WITH THE PAWN LOGO ON IT, SHE DECIDED TO GO TO SOME OF THE PAWN SHOPS WHERE SHE OBTAINED A
RECEIPT SHOWING VICKERS PAWNING HER STEREO AT ABBA PAWN IN BRADENTON ON 08-21-17. I RAN VICKERS
THROUGH THE PAWN DATABASE AND FOUND WOLFE'S STOLEN LAPTOP HAD BEEN PAWNED BY VICKERS AT AMERICAS
SUPERPAWN ON 08-23-17. WOLFE PROVIDED THE RECEIPT FOR HER LAPTOP WITH THE MATCHING SERIAL NUMBER AND
THE VALUE OF $1499. HER JVC STEREO IS VALUED AT $300. I PLACED THE WATER BOTTLE FROM THE PAWN SHOP
THAT WAS FOUND IN THE VICTIM'S VEHICLE WHERE HER STEREO HAD BEEN TAKEN, INTO PROPERTY AND EVIDENCE.
VICTIM WOLFE FILLED OUT AN AFFIDAVIT CONCERNING HER CONFRONTATION WITH DAVID VICKERS OVER HER STOLEN
PROPERTY AND PROVIDED THE RECEIPTS FOR THE STOLEN LAPTOP AND RECEIPT FROM ABBA PAWN. I NOTIFIED
DET-SGT HALL CONCERNING THE CASE.
NA
RR
AT
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Original Date Reported
NARRATIVE CONTINUATION
Case ReferenceAD
M
Date of Supplement Agency ORI Number
1. Offense
2. Arrest
Juvenile
Warn/Dismiss
1. Original
2. Supplement
Agency Report Number
Case Status
Routed To Referred To
Related Report Number(s)
Unit
of
Page
Number ArrestedClearance Type
Exception Type 2. Arrest on Primary OffenseSecondary Offense Without Prosecution
3. Death of Offender4. V / W Refused to Cooperate
3.Unfounded
Page
Date
5. Prosecution Declined6. Juvenile/No Custody1.Extradition Declined
1.Arrest2.Exceptional
OBTS Number
Date Cleared
ByAssigned To
AD
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A-AdultJ-Juvenile
Date
Name of Officer Reporting
Officer Reviewing (If Applicable) I.D. Number
I.D. Number/Locator CodeReport Contains
Arrest Number
__/__/____
08/26/2017
08/27/2017
__/__/____
__/__/____
USA Rev. 01/21/2003
Signature of Officer Reporting
Signature of Officer Reviewing
C O P
Y
Holmes Beach Police Department 20170716
5610 SOLITAIRE PALM WAY
V262165853790
606
33572APOLLO BEACH
31 290
VICKERS DAVID E1 2A
FL
MW
N 2
BLU BLD X
FL
HEV
___-_______
___-__-____
___ ___-____
___-_______
___ ___-____
___-_______
813 468-8565
___-__-____
___-_______
___ ___-____
311DET SGT HALL
THEFT WOLFE MELISA
NUMEROUS
1
CO
DE
SA
DM
Juvenilein Report:
Date of Supplement
Primary Offense Description
Victim Type Race
Victim Relationship To Offender
Agency Report Number
Residence Type Residence Status4. Business5. Government6. Church9. Other
SexN-N/AM-MaleF-FemaleU-Unknown
0. N/A1. City2. County
3. Florida4. Out-of-State
0. N/A1. Full Year2. Part Year3. Non-Resident
0. None1. Minor2. Serious3. Fatal
07. Loss of Teeth08. Burns09. Abrasions/Bruises99. Other
00. N/A01. Undetermined02. Stranger
03. Spouse04. Ex-Spouse05. Co-Habitant
06. Parent07. Brother/Sister08. Child09. Step-Parent
14. Teacher15. Child of Boy/Girl Friend16. Boy/Girl Friend
17. Friend18. Neighbor19. Sitter/Day Care20. Employee
21. Employer22. Landlord/Tenant23. Acquaintance99. Other Known
PERSON(S) REPORT
Injury Type
00. N/A01. Gunshot02. Stabbed
Original Date Reported
1. Original2. Supplement:
0. N/A1. Juvenile2. L.E. Officer3. Adult
N-N/AW-WhiteB-Black
I-American IndianO-Oriental/AsianU-Unknown
03. Laceration04. Unconscious05. Poss. Broken Bones06. Poss. Internal Injury
10. Step-Child11. In-Law12. Other Family13. Student
Victim #1 Name (Last, First, Middle)
V/W CodeV - VictimW - WitnessC - Reporting Person
O - Other
Will Victim prefer charge?
Will Victim prefer charge?
Extent of Injury
SU
SP
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TO
RM
ISS
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PE
RS
ON
S
If V/W Code isV, W or C
Fill in this LineOFF/INC Indicator
OFF/INC Indicator V/W Code # Name (Last, First, Middle or Business) Residence Phone
Business Phone
Race Sex Injury Type(s) Relationship Ethnicity
Synopsis of Involvement
V. Type
V/W Code # Name (Last, First, Middle or Business) Residence Phone
Business Phone
Race Sex Relationship Ethnicity
Synopsis of Involvement
Extent of InjuryRes. StatusRes. Type
ZipStateCity
Extent of InjuryRes. StatusRes. Type
ZipStateCity
VIC
TIM
/W
ITN
ES
SV
ICT
IM/W
ITN
ES
S
Dom. Violence
Dom. Violence
1.#12.#2
3.Both
1.#12.#2 3.Both
Date of Birth Age
Date of Birth Age
If V/W Code isV, W or C
Fill in this Line
Address (Street, Apt. Number)
Address (Street, Apt. Number)
Other Contact Info. (Time Available, Interpreter, etc.)
Other Contact Info. (Time Available, Interpreter, etc.)
SU
SP
EC
TO
RM
ISS
ING
PE
RS
ON
S
Hair Color
Suspect Code Code
Maiden Name
Occupation
Driver's License State/Number
Employer/School
Immigration and Naturalization Number Other ID. Number
Address
Place of Birth Residence Phone
Business Phone
Social Security Number
OBTS Number
Date of Birth or Age Height
Complexion Facial Hair Teeth Speech/Voice Special Identifiers
Eye Color Hair Length Hair Style
Name (Last, First, Middle)
Clothing (Describe)
Last Known Address (Street, Apt. Number)
OFF/INC Indicator
1.#12.#2
Sex
Nickname/Street Name
SCIC/NCIC
WeightRace
Juvenile
Build
3.Both
City
Maiden Name
Occupation
Driver's License State/Number
Employer/School
Immigration and Naturalization Number Other ID. Number
Address
Place of Birth Residence Phone
Business Phone
Social Security Number
OBTS Number
Date of Birth Height
Complexion Facial Hair Teeth Speech/Voice Special Identifiers
Eye Color Hair Length Hair Style
State Zip
Clothing (Describe)
Last Known Address (Street, Apt. Number)
Sex
Nickname/Street Name
SCIC/NCIC
Hair ColorWeightRace
Build
Code Name (Last, First, Middle)OFF/INC Indicator
1.#12.#2
Juvenile
3.Both
Susp. #
E-EscapeeM-Missing
Suspect Code
S-SuspectA-Arrestee
R-Rec. MissingZ-other
Susp. #
Age
V. Type
E-EscapeeM-Missing
S-SuspectA-Arrestee
R-Rec. MissingZ-other
Injury Type(s)
ZipStateCity
Scars/Marks/Tatoos (Location/Describe)
Scars/Marks/Tatoos (Location/Describe)
MIS
SIN
GP
ER
SO
N/
RU
NA
WA
Y 7. VoluntaryAdult
8. Unknown
1. Yes2. No8. Unknown
Incident Type
1. Runaway2. Parental3. Involuntary
Foul Play Suspected ?
1. Yes2. No
Missing Before ?
1. Yes2. No8. Unknown
1. Yes2. No8. Unknown
1. Yes2. No8. Unknown
MCIC Form Provided ?
4. Disabled5. Endangered6. Disaster Victim
Fingerprints Available? Dental Record Available
1. Yes2. No
Photo Available?
Date Last Seen Time Last Seen Accompanied By
Property Carried
Probable Destination
Medication Required/Type
ID. Type/Number
Recovery Information7. Deceased9. Other
Doctor/Dentist (Name, Phone Number)
Transportation Mode
Location Last Seen (Address, City, St.)
5. Law Enforcement Custody6. Returned to Parent
3. Hospitalized4. HRS Custody
2. Located-Not Returned
0. N/A1. Voluntary
Name/Address
ID. Type/Number
Mental/Physical Condition
AD
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DateID. Number Routed To Referred To Assigned To
Officer(s) Reporting Date
By
of
PagePage
Officer Reviewing (If Applicable)
USA Rev. 01/21/2003
__/__/____
__/__/____
__/__/____
08/31/2017
08/25/2017
10/19/1985
Signature of Officer Reporting
Signature of Officer Reviewing
YYeess NNoo
YYeess NNoo
C O P
Y
NA
RR
AT
IVE
Original Date Reported
NARRATIVE CONTINUATION
THEFT
Holmes Beach Police Department
Case ReferenceAD
M
Date of Supplement Agency ORI Number
1. Offense
2. Arrest
Juvenile
Warn/Dismiss
1. Original
2. Supplement
Agency Report Number
FL0410400 20170716
1 2
ON 08-29-2017, I WENT TO THE ABBA PAWN SHOP, 5681 15TH ST E. BRADENTON, WHERE THE VICTIM
HAD FOUND HER CAR STEREO PAWNED BY HER LIVE IN BOYFRIEND. I ALSO SEARCHED THE RAPID
PAWN DATABASE AND CONFIRMED THAT HE HAD SOLD THE STEREO THERE. I ALSO LOCATED THE
STOLEN LAPTOP AT THE AMERICA SUPER PAWN #3, 5137 14TH ST W. BRADENTON. I PLACED A HOLD
ON BOTH OF THE ITEMS AND PHOTOGRAPHED THE ITEMS. I MATCHED THE SERIAL NUMBER ON THE
LAPTOP TO THE RECEIPT PROVIDED BY THE VICTIM. I TOOK POSSESSION OF THE ORIGINAL PAWNSLIPS.
I TOOK THE PAWN SLIPS TO THE MCSO FINGERPRINT UNIT. THE THUMB PRINT WAS CONFIRMED TOBE THE RIGHT THUMB PRINT OF DAVID VICKERS ON BOTH SLIPS.
ON 08-30-2017, A WARRANT WAS SIGNED FOR GRAND THEFT OF THE ITEMS. THE WARRANT WAS
DELIVERED TO THE JAIL, AS THE DEFENDANT WAS ALREADY INCARCERATED. THE MANATEE
COUNTY SHERIFF'S OFFICE WROTE THE WARRANTS FOR THE PAWN FRAUD AND DEALING IN STOLENPROPERTY. THIS CASE IS CLEARED WITH AN ARREST.
Case Status
Routed To Referred To
Related Report Number(s)
Unit
of
Page
Number ArrestedClearance Type
Exception Type 2. Arrest on Primary OffenseSecondary Offense Without Prosecution
3. Death of Offender4. V / W Refused to Cooperate
3.Unfounded
Page
Date
5. Prosecution Declined6. Juvenile/No Custody1.Extradition Declined
1.Arrest2.Exceptional
OBTS Number
Date Cleared
ByAssigned To
AD
MIN
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A-AdultJ-Juvenile
Date
Name of Officer Reporting
Officer Reviewing (If Applicable) I.D. Number
I.D. Number/Locator Code
111 ACA
DET SGT HALL 311
Report Contains
Arrest Number
__/__/____
__/__/____
08/31/2017
USA Rev. 01/23/2003
08/31/2017
08/26/2017
Signature of Officer Reviewing
Signature of Officer Reporting
C O P
Y
FL0410400
01
00
1035
1 1 UK 1 0
UNKNOWN
Holmes Beach Police Department
1035 1040 1207
0800 1035
20170717 BURGLARY
Mon
Fri Mon
1 HUMES
105 7TH ST. N. BRADENTON BEACH 34217
56
1
517 71ST ST. HOLMES BEACH 34217
WF74
JAMES FRED
BOLAY BRENDA
2
2
MW
W
C 3
V 3
S
2
1
1
1
0
0
00
00
17
0100
00
FL
FL
1
JASON HIGGINS
SGT.COPEMAN 307
DET
2 3b 2200810CBURGLARY
___-_______
___-__-____
941 779-0100
___-_______
941 704-4745
___-_______
___ ___-____
34217 W80
RESIDENCE
71ST STREET HOLMES BEACH517
1 2
1
1
1
3
331
1
CARETAKER
OWNER OF HOUSE
WM
F
SEE SECOND PAGE NARRATIVE.
N2 1
00. N/A
01. Gunshot
02. Stabbed
OFF/INC Indicator
EV
EN
TD
AT
AN
AR
RA
TIV
ES
US
PE
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CO
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SA
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A-AttemptedC-Committed
A-AttemptedC-Committed
Area
Type of Weapon
01. Residence Single02. Apartment/Condo03. Residence-Other04. Hotel/Motel
Time (mil)
GangRelated
Time Dispatched (mil)
Primary Offense Description
21. Employer
22. Landlord/Tenant
23. Acquaintance
99. Other Known
5. Ordinance9. Other
Zone
)
Agency Report Number
3. Misdemeanor4. Traffic Misdemeanor
OFF/INC# 1
Business Name/Area Identifier
District
NCIC/UCR Code
2. No
Location Type
V/W Code
# Victims
00. N/A01. Handgun
05. Knife/CuttingInstrument
06. Blunt Object
07. Hands/Fist/Feet08. Poison09. Explosives
10. Fire/Incendiary11. Threat/Intimidation12. Simulated Weapon
V - Victim
W - Witness
C - Reporting Person
O - Other
Race
N - N/A
M - Male
F - Female
U - Unknown
Residence Type
0. N/A
1. City
2. County
Extent of InjuryResidence Status
03. Laceration
04. Unconscious
05. Poss. Broken Bones
06. Poss. Internal Injury
Victim Relationship To Offender07. Loss of Teeth
08. Burns
09. Abrasions/Bruises
99. Other
06. Parent
07. Brother/Sister
08. Child
09. Step-Parent
10. Step-Child
11. In-Law
12. Other Family
13. Student
Residence Phone
Business Phone
Juvenille
Occupation
Sex Date of Birth Height Weight Eye Color Hair Length Hair Style
Nickname/Street Name Place of Birth
Social Security Number
SCIC/NCIC
Employer/School
Teeth Speech/Voice Special Identifiers
Original DayReported
Date Time (mil) Time Arrived (mil) Time Completed (mil)
1. Felony2. Traffic Felony To
Time (mil)
(-
Type
15. Industrial/Mfg.16. Storage17. Gov't/Public Bldg.18. School/University19. Jail/Prison
20. Religious Bldg.21. Airport22. Bus/Rail Terminal23. Construction Site24. Other Structure
25. Parking Lot/Garage26. Highway/Roadway27. Park/Woodlands/Field28. Lake/Waterway29. Motor Vehicle
10. Dept/Discount Store11. Specialty Store12. Drug Store/Hospital13. Bank/Financial Inst.14. Commercial/Office Bldg.
Suspect Code
Incident Location (Street Number, Street, Apt,)
Scars/Marks/Tatoos (Location/Describe)
OFFENSE-INCIDENT REPORT
0. N/A1. Occupied
E-EscapeeM-Missing
From
Date of Supplement
- (
17. Friend
18. Neighbor
19. Sitter/Day Care
20. Employee
OFF/INC Indicator
OBTS Number (Arrested)Other I.D. NumberImmigration and Naturalization Number
Incident Type Incident: Day Date
2. Unoccupied3. Abandoned
05. Convenience Store06. Gas Station07. Liquor Sales08. Bar/Nightclub09. Supermarket
DateDay
0. N/A1. Yes
Forced Entry Occupancy
Statute Violation Number - Chapter, Section, SubDescriptionType
Hair ColorRace
Facial HairBuildComplexion
Driver's License Number/State
Address
Code
Maiden Name
Name (Last, First, Middle)
13. Drugs88. Unknown99. Other
Grid
Victim Type0. N/A
1. Juvenile
2. L.E. Officer
3. Adult
4. Business
5. Government
6. Church
9. Other
Sex
I - American Indian
O - Oriental/Asian
U - Unknown
N - N/A
W - White
B - Black
3. Florida
4. Out-of-State
0. N/A
1. Full Year
2. Part Year
3. Non-Resident
0. None
1. Minor
2. Serious
3. Fatal
14. Teacher
15. Child of Boy/Girl
Friend
16. Boy/Girl Friend
03. Spouse
04. Ex-Spouse
05. Co-Habitant
00. N/A
01. Undetermined
02. Stranger
Injury Type
Clothing (Describe)
ZipStateCity
02. Rifle03. Shotgun04. Firearm
# Prem. Ent.
S-SuspectA-Arrestee
ZipCity
# OFF/INC. # Offenders # Veh. Stolen
1.#12.#2
3.Both
)
If V/W Code isV, W or C
Fill in this LineOFF/INC Indicator
V/W Code # Name (Last, First, Middle or Business) Residence Phone
Business Phone
Race Sex Injury Type(s) Relationship Ethnicity Will Victim prefer charge?
Synopsis of Involvement
V. Type
V/W Code # Name (Last, First, Middle or Business) Residence Phone
Business Phone
Race Sex Injury Type(s) Relationship Ethnicity Will Victim prefer charge?
Synopsis of Involvement
V. Type
Extent of InjuryRes. StatusRes. Type
ZipStateCity
Extent of InjuryRes. StatusRes. Type
ZipStateCity
VIC
TIM
/W
ITN
ES
SV
ICT
IM/W
ITN
ES
S
Dom. Violence
Dom. Violence
1.#12.#2
3.Both
1.#12.#2
3.Both
Date of Birth Age
Date of Birth Age
If V/W Code isV, W or C
Fill in this Line
Address (Street, Apt. Number)
Other Contact Info. (Time Available, Interpreter, etc.)
Address (Street, Apt. Number)
Other Contact Info. (Time Available, Interpreter, etc.)
Last Known Address (Street, Apt. Number)
OFF/INC# 2
R-Rec. MissingZ-other
Age
Person/Unit Notified
Case Status
Time
Routed To Referred To
Related Report Number(s)
Unit
of
Page
Number ArrestedClearance Type
Exception Type2. Arrest on Primary Offense
Secondary Offense Without Prosecution3. Death of Offender4. V / W Refused to Cooperate
3.Unfounded
Page5. Prosecution Declined6. Juvenile/No Custody1.Extradition Declined
1.Arrest2.Exceptional
Jail Number
OBTS Number
Date Cleared
AD
MIN
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RA
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A-AdultJ-Juvenile
Date
Name of Officer Reporting
Officer Reviewing (If Applicable) I.D. Number
I.D. Number/Locator Code
By DateAssigned To
30. Other Mobile99. Other
Susp.#
JuvenileWarn/Dismiss:
1. Original2. Supplement:
Juvenilein Report:
__/__/____
08/28/2017
07/28/2017 08/28/2017
__/__/____
08/28/2017
__/__/____
USA Rev. 01/21/2003
12/06/1960
11/19/1942
Signature of Officer Reporting
Signature of Officer Reviewing
YYeess NNoo
Yes No
C O P
Y
Type
Type
Type
Holmes Beach Police Department20170717
N/A N/A
1
WHITE DOOR (FRONT OF HOUSE) DAMAGED
STANDARD1 FRONT DOOR1
N/A N/A MISC. COINS, NO DESCRIPTION.
MISC2 COINS1
N/A N/A MISC. WOMEN'S JEWELRY
MISC3 NECKLACES1
N/A N/A
1
MEDIUM-HEAVY BRONZE SAFE, DAMAGED.
STEEL4 SAFE1
N/A N/A
1
LARGE RUBBER MALLET.
LARGE5 RUBBER MALLET1
3
V
V
V
R
3
3
3
3
Z
J
J
Z
E
200.00
100.00
100.00
600.00
9
1
9
8
1
01
1. HOUSE'S FRONT DOOR HAD BEEN PRIED OPEN WITH A CROWBAR OR IT'S EQUIVALENT, AND DAMAGED BY THAT;2. COINS, WITH NO DESCRIPTION WERE STOLEN FROM SAFE;3. UNKNOWN AMOUNT OF NECKLACES WITHOUT DESCRIPTION;4. RUBBER MALLET, USED TO BREAK INTO THE SAFE;
1,000.00
0.00
DET
331
SGT.COPEMAN
JASON HIGGINS
307
32
1
BURGLARY HUMES JAMES FRED
V
TH
EF
TA
DM
A. Auto Accessory/PartsB. BicycleC. Camera/Photo EquipmentD. Drug
T. TV/Video/VCRU. Currency/NegotiableV. Credit Card/Non-NegotiableW. Boat MotorX. Structure
Property TypeO. Office EquipmentP. Art/CollectionQ. Computer EquipmentR. Radio/StereoS. Sports Equipment
E. Equipment/Tool.F. Food/Liquor/ConsumableG. GunH. Household Appliance/GoodsI. Plant/Citrus
J. Jewelry/Precious MetalK. Clothing/FurL. LivestockM. Musical InstrumentN. Construction Machinery
Date of Supplement
Original Date Reported Primary Offense Description Victim #1 Name (Last, First, Middle)
Agency Report Number
1. Original2. SupplementPROPERTY REPORT
Y. Farm EquipmentZ. Miscellaneous
PR
OP
.D
ET
AIL
/N
AR
R.
CO
DE
S
09. From Vehicle10. Extortion
Theft Type Codes
04. Pocket Picking05. Purse Snatching
06. Embezzlement07. From Coin Oper. Machine
08. From PublicAccess Building
11. By Computer12. Fraud
99. Other00. N/A01. Burglary
02. Robbery03. Shoplifting
Theft Type
A - ArresteeO - Other
1. Stolen2. Recovered
V - VictimS - Suspect
5. Lost6. Found
Person Codes Status Codes
3. Stolen and Recovered4. Recovered for Other Jurisdiction
2. Criminal Mischief3. During other Offense
7. Safekeeping8. Evidence/Seized
9. Other9. Other
Damage Codes
0. N/A1. Arson
PR
OP
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TY
Serial Number
NameItem #Code Person Status Damage Property Type Quantity Brand Model Name/Number
Owner Applied Number Description (Size, Color, Caliber, Barrel Length, Etc. )
Value Value Recovered Date Recovered SCIC/NCIC
PropertyStolen
PropertyRecovered
Change in PropertyStolen Value
Change in PropertyRecovered Value
Activity Type Unit
Activity Description Quantity Unit
P. PossessS. SellB. BuyT. Traffic
R. SmuggleD. DeliverE. UseK. Dispense/Distribute
M. Manufacture/Produce/CultivateZ. Other
A. AmphetamineB. BarbiturateC. CocaineE. Heroin
H. HallucinogenM. MarijuanaO. Opium/DerivativeP. Paraphernalia/Equipment
S. SyntheticU. UnknownZ. Other
1. Gram2. Milligram3. Kilogram4. Ounce
5. Pound6. Ton7. Liter8. Milliliter
Estimated Street Value
TO
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CO
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SD
RU
GS
PR
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Serial Number
NameItem #Code Person Status Damage Property Type Quantity Brand Model Name/Number
Owner Applied Number Description (Size, Color, Caliber, Barrel Length, Etc. )
Value Value Recovered Date Recovered SCIC/NCIC
PR
OP
ER
TY
Serial Number
NameItem #Code Person Status Damage Property Type Quantity Brand Model Name/Number
Owner Applied Number Description (Size, Color, Caliber, Barrel Length, Etc. )
Value Value Recovered Date Recovered SCIC/NCIC
PR
OP
ER
TY
Serial Number
NameItem #Code Person Status Damage Property Type Quantity Brand Model Name/Number
Owner Applied Number Description (Size, Color, Caliber, Barrel Length, Etc. )
Value Value Recovered Date Recovered SCIC/NCIC
PR
OP
ER
TY
Serial Number
NameItem #Code Person Status Damage Property Type Quantity Brand Model Name/Number
Owner Applied Number Description (Size, Color, Caliber, Barrel Length, Etc. )
Value Value Recovered Date Recovered SCIC/NCIC
Activity Description Quantity Unit Estimated Street Value
Activity Description Quantity Unit Estimated Street Value
AD
MIN
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E
ID. Number(s)/Locator code Unit
DateID. Number Routed To Referred To Assigned To
Officer(s) Reporting Date
By
of
PagePage
Officer Reviewing (If Applicable)
Signature of Officer Reviewing
Signature of Officer Reporting
9. Dose Unit/Item
__/__/____
08/28/2017
08/28/2017
__/__/____
__/__/____
08/28/2017
__/__/____
08/28/2017
__/__/____
USA Rev. 01/21/2003
C O P
Y
Holmes Beach Police DepartmentFL0410400 20170717
1 1
DET
33
JASON HIGGINS
SGT.COPEMAN 307
331
I RESPONDED TO 517 71ST ST., HOLMES BEACH, FL. FOR A BURGLARY TO RESIDENCE. UPON ARRIVAL, I MET
WITH CARETAKER OF PROPERTY, JAMES HUMES. HUMES PARKS HIS BOAT BEHIND RESIDENCE AND IS CURRENTLY TAKING
CARE OF THE PROPERTY BY CHECKING THE INTERIOR OF THE DWELLING TO MAKE SURE IT IS SECURE. APPROXIMATELY
A MONTH AGO, THE PROPERTY OWNER, BRENDA BOLAY, LEFT TO GO OUT-OF-STATE. AND THIS WAS THE FIRST TIME HE
HAD BEEN THERE TO CHECK THE INSIDE.
TODAY, HUMES WENT TO THE FRONT DOOR AND NOTICED THE BOTTOM LOCK WAS LOCKED. WHEN HE OPENED THE
DOOR HE COULD CLEARLY SEE THAT THE DEADBOLT WAS MISSING AND THE DOOR WAS DAMAGED FROM A CROWBAR OR
SOME OTHER PRYING INSTRUMENT BEING USED AS THE TOOL TO GAIN ENTRY TO THE RESIDENCE. HUMES WENT INSIDE
AND NOTICED THE SAFE LAYING ON THE GROUND ON A RUG IN THE OFFICE. HUMES CALLED H.B.P.D. AS SOON AS HE
DISCOVERED THE BURGLARY.
THE SAFE WAS ORIGINALLY KEPT INSIDE A HALLWAY CLOSET--JUST RIGHT OUTSIDE THE OFFICE. THE BRONZE
SAFE WAS HEAVY, MEDIUM SIZED, AND LAYING ON IT'S BACK. THE DOOR WAS REMOVED BY SOMEONE REMOVING THE
PINS TO THE DOOR AND PRYING IT OPEN WITH AN UNKNOWN TOOL. THE DOOR WAS ON THE GROUND ALONG SIDE THE
METAL DRAWERS FROM THE SAFE. OFFICER STEVE OGLINE OBSERVED A LARGE RUBBER MALLET ON THE DESK LOCATED
INSIDE THE OFFICE, APPROXIMATELY 3 FEET AWAY FROM THE SAFE. HUMES SAID THAT THE MALLET LOOKS
OUT-OF-PLACE, AND DOESN'T BELONG TO THE HOUSE. OFFICER OGLINE TOOK A PICTURE OF MALLET AND IT'S
LOCATION AND SEIZED IT AS EVIDENCE. OFFICER OGLINE TOOK PICTURES OF THE SAFE AND THE FRONT DOOR.
I CANVASSED THE REST OF THE HOUSE FOR OTHER ENTRY OR EXIT POINTS. ALL WINDOWS AND DOORS AROUND
THE EXTERIOR OF THE HOUSE HAVE HURRICANE SHUTTERS ON THEM AND WERE SECURE. HUMES AND I, WALKED THROUGH
THE ROOMS, AND WE COULD NOT LOCATE ANYTHNG ELSE THAT WAS DISTURBED.
I DUSTED THE SAFE AND DRAWERS FOR FINGERPRINTS AND WAS UNABLE TO LOCATE ANY. I DUSTED THE FRONT
DOOR AND WAS ABLE TO FIND LAYERS OF SMUDGES FROM WHERE PEOPLE HAD PULLED THE DOOR OPEN, APPROXIMATELY
A FOOT ABOVE THE DEADBOLT.
I SPOKE TO HOME OWNER AND SHE SAID THE CONTENTS INSIDE THE SAFE WERE: ASSORTED NECKLACES AND
COINS WITH A TOTAL VALUE AT $200.00. SHE WAS UNABLE TO GIVE ME A DESCRIPTION OF CONTENTS THEREIN.
HUMES WAS ISSUED A CASE NUMBER, CARD, AND TOLD TO CALL H.B.P.D. TO FOLLOW UP WITH US IF ANYTHING ELSE
WAS STOLEN WHEN SHE RETURNS.
NA
RR
AT
IVE
Original Date Reported
NARRATIVE CONTINUATION
Case ReferenceAD
M
Date of Supplement Agency ORI Number
1. Offense
2. Arrest
Juvenile
Warn/Dismiss
1. Original
2. Supplement
Agency Report Number
Case Status
Routed To Referred To
Related Report Number(s)
Unit
of
Page
Number ArrestedClearance Type
Exception Type 2. Arrest on Primary OffenseSecondary Offense Without Prosecution
3. Death of Offender4. V / W Refused to Cooperate
3.Unfounded
Page
Date
5. Prosecution Declined6. Juvenile/No Custody1.Extradition Declined
1.Arrest2.Exceptional
OBTS Number
Date Cleared
ByAssigned To
AD
MIN
IST
RA
TIV
E
A-AdultJ-Juvenile
Date
Name of Officer Reporting
Officer Reviewing (If Applicable) I.D. Number
I.D. Number/Locator CodeReport Contains
Arrest Number
__/__/____
08/28/2017
08/28/2017
__/__/____
__/__/____
USA Rev. 01/21/2003
Signature of Officer Reporting
Signature of Officer Reviewing
C O P
Y
NA
RR
AT
IVE
Original Date Reported
NARRATIVE CONTINUATION
BURGLARY (DWELLING)
Holmes Beach Police Department
Case ReferenceAD
M
Date of Supplement Agency ORI Number
1. Offense
2. Arrest
Juvenile
Warn/Dismiss
1. Original
2. Supplement
Agency Report Number
FL0410400 20170717
1 2
I RESPONDED TO 517 71st STREET TO ASSIST OFC HIGGINS WITH A BURGLARY INVESTIGATION. UPON ARRIVAL, I
WALKED THE SCENE WITH OFC HIGGINS AND WE OBSERVED PRY MARKS ON THE FRONT DOOR, FRONT DOOR JAMB, AND
SAFE. WE ALSO LEARNED FROM THE COMPLAINANT THAT A RUBBER MALLET WAS LEFT ON THE DESK IN THE SOUTH-
WEST BEDROOM WHERE A SAFE HAD BEEN BROKEN INTO. I RETRIEVED MY DEPARTMENT ISSUED CAMERA AND TOOK A
SERIES OF 16 PHOTOGRAPHS DOCUMENTING THE SCENE FROM THE FRONT DOOR TO THE BEDROOM, INCLUDING THE
MALLET LYING ON THE DESK. I SECURED THE MALLET AS EVIDENCE AND LATER PUT IT INTO PROPERTY & EVIDENCE
ALONG WITH A LAB REQUEST FORM ASKING TO HAVE IT EXAMINED FOR POSSIBLE DNA AND FINGERPRINT EVIDENCE. I
ALSO UPLOADED THE DIGITAL IMAGES INTO THE CASE FILES DATABASE OF THE HBPD INTRANET. I TOOK NFA.
Case Status
Routed To Referred To
Related Report Number(s)
Unit
of
Page
Number ArrestedClearance Type
Exception Type 2. Arrest on Primary OffenseSecondary Offense Without Prosecution
3. Death of Offender4. V / W Refused to Cooperate
3.Unfounded
Page
Date
5. Prosecution Declined6. Juvenile/No Custody1.Extradition Declined
1.Arrest2.Exceptional
OBTS Number
Date Cleared
ByAssigned To
AD
MIN
IST
RA
TIV
E
A-AdultJ-Juvenile
Date
Name of Officer Reporting
Officer Reviewing (If Applicable) I.D. Number
I.D. Number/Locator Code
OGLINE
SGT.COPEMAN 307
322
Report Contains
Arrest Number
08/28/2017
__/__/____
__/__/____
USA Rev. 01/23/2003
08/28/2017
08/28/2017
Signature of Officer Reviewing
Signature of Officer Reporting
C O P
Y
FL0410400
01
03
1347
02 01 UK 02 00
Holmes Beach Police Department
1348 1353 1522
1500 1200
20170719 BURGLARY
Mon
Mon Sun
1 MOORE
502 72nd ST HOLMES BEACH 34217
86
BOBBY L
2 MW
V 3
1 2 0 00 0000
FL
OGLINE
SGT.COPEMAN 307
DET
2 2b 2200
2 4b 2200CBURGLARY
810
810
CBURGLARY
___-_______
___-__-____
863 648-7875
___-_______
___ ___-____
___-_______
___ ___-____
3421772nd STREET HOLMES BEACH502
1 2
1
1
3
322
SEE NARRATIVE
N2 1
00. N/A
01. Gunshot
02. Stabbed
OFF/INC Indicator
EV
EN
TD
AT
AN
AR
RA
TIV
ES
US
PE
CT
CO
DE
SA
DM
A-AttemptedC-Committed
A-AttemptedC-Committed
Area
Type of Weapon
01. Residence Single02. Apartment/Condo03. Residence-Other04. Hotel/Motel
Time (mil)
GangRelated
Time Dispatched (mil)
Primary Offense Description
21. Employer
22. Landlord/Tenant
23. Acquaintance
99. Other Known
5. Ordinance9. Other
Zone
)
Agency Report Number
3. Misdemeanor4. Traffic Misdemeanor
OFF/INC# 1
Business Name/Area Identifier
District
NCIC/UCR Code
2. No
Location Type
V/W Code
# Victims
00. N/A01. Handgun
05. Knife/CuttingInstrument
06. Blunt Object
07. Hands/Fist/Feet08. Poison09. Explosives
10. Fire/Incendiary11. Threat/Intimidation12. Simulated Weapon
V - Victim
W - Witness
C - Reporting Person
O - Other
Race
N - N/A
M - Male
F - Female
U - Unknown
Residence Type
0. N/A
1. City
2. County
Extent of InjuryResidence Status
03. Laceration
04. Unconscious
05. Poss. Broken Bones
06. Poss. Internal Injury
Victim Relationship To Offender07. Loss of Teeth
08. Burns
09. Abrasions/Bruises
99. Other
06. Parent
07. Brother/Sister
08. Child
09. Step-Parent
10. Step-Child
11. In-Law
12. Other Family
13. Student
Residence Phone
Business Phone
Juvenille
Occupation
Sex Date of Birth Height Weight Eye Color Hair Length Hair Style
Nickname/Street Name Place of Birth
Social Security Number
SCIC/NCIC
Employer/School
Teeth Speech/Voice Special Identifiers
Original DayReported
Date Time (mil) Time Arrived (mil) Time Completed (mil)
1. Felony2. Traffic Felony To
Time (mil)
(-
Type
15. Industrial/Mfg.16. Storage17. Gov't/Public Bldg.18. School/University19. Jail/Prison
20. Religious Bldg.21. Airport22. Bus/Rail Terminal23. Construction Site24. Other Structure
25. Parking Lot/Garage26. Highway/Roadway27. Park/Woodlands/Field28. Lake/Waterway29. Motor Vehicle
10. Dept/Discount Store11. Specialty Store12. Drug Store/Hospital13. Bank/Financial Inst.14. Commercial/Office Bldg.
Suspect Code
Incident Location (Street Number, Street, Apt,)
Scars/Marks/Tatoos (Location/Describe)
OFFENSE-INCIDENT REPORT
0. N/A1. Occupied
E-EscapeeM-Missing
From
Date of Supplement
- (
17. Friend
18. Neighbor
19. Sitter/Day Care
20. Employee
OFF/INC Indicator
OBTS Number (Arrested)Other I.D. NumberImmigration and Naturalization Number
Incident Type Incident: Day Date
2. Unoccupied3. Abandoned
05. Convenience Store06. Gas Station07. Liquor Sales08. Bar/Nightclub09. Supermarket
DateDay
0. N/A1. Yes
Forced Entry Occupancy
Statute Violation Number - Chapter, Section, SubDescriptionType
Hair ColorRace
Facial HairBuildComplexion
Driver's License Number/State
Address
Code
Maiden Name
Name (Last, First, Middle)
13. Drugs88. Unknown99. Other
Grid
Victim Type0. N/A
1. Juvenile
2. L.E. Officer
3. Adult
4. Business
5. Government
6. Church
9. Other
Sex
I - American Indian
O - Oriental/Asian
U - Unknown
N - N/A
W - White
B - Black
3. Florida
4. Out-of-State
0. N/A
1. Full Year
2. Part Year
3. Non-Resident
0. None
1. Minor
2. Serious
3. Fatal
14. Teacher
15. Child of Boy/Girl
Friend
16. Boy/Girl Friend
03. Spouse
04. Ex-Spouse
05. Co-Habitant
00. N/A
01. Undetermined
02. Stranger
Injury Type
Clothing (Describe)
ZipStateCity
02. Rifle03. Shotgun04. Firearm
# Prem. Ent.
S-SuspectA-Arrestee
ZipCity
# OFF/INC. # Offenders # Veh. Stolen
1.#12.#2
3.Both
)
If V/W Code isV, W or C
Fill in this LineOFF/INC Indicator
V/W Code # Name (Last, First, Middle or Business) Residence Phone
Business Phone
Race Sex Injury Type(s) Relationship Ethnicity Will Victim prefer charge?
Synopsis of Involvement
V. Type
V/W Code # Name (Last, First, Middle or Business) Residence Phone
Business Phone
Race Sex Injury Type(s) Relationship Ethnicity Will Victim prefer charge?
Synopsis of Involvement
V. Type
Extent of InjuryRes. StatusRes. Type
ZipStateCity
Extent of InjuryRes. StatusRes. Type
ZipStateCity
VIC
TIM
/W
ITN
ES
SV
ICT
IM/W
ITN
ES
S
Dom. Violence
Dom. Violence
1.#12.#2
3.Both
1.#12.#2
3.Both
Date of Birth Age
Date of Birth Age
If V/W Code isV, W or C
Fill in this Line
Address (Street, Apt. Number)
Other Contact Info. (Time Available, Interpreter, etc.)
Address (Street, Apt. Number)
Other Contact Info. (Time Available, Interpreter, etc.)
Last Known Address (Street, Apt. Number)
OFF/INC# 2
R-Rec. MissingZ-other
Age
Person/Unit Notified
Case Status
Time
Routed To Referred To
Related Report Number(s)
Unit
of
Page
Number ArrestedClearance Type
Exception Type2. Arrest on Primary Offense
Secondary Offense Without Prosecution3. Death of Offender4. V / W Refused to Cooperate
3.Unfounded
Page5. Prosecution Declined6. Juvenile/No Custody1.Extradition Declined
1.Arrest2.Exceptional
Jail Number
OBTS Number
Date Cleared
AD
MIN
IST
RA
TIV
E
A-AdultJ-Juvenile
Date
Name of Officer Reporting
Officer Reviewing (If Applicable) I.D. Number
I.D. Number/Locator Code
By DateAssigned To
30. Other Mobile99. Other
Susp.#
JuvenileWarn/Dismiss:
1. Original2. Supplement:
Juvenilein Report:
__/__/____
08/28/2017
08/14/2017 08/27/2017
__/__/____
08/28/2017
__/__/____
USA Rev. 01/21/2003
07/03/1931
Signature of Officer Reporting
Signature of Officer Reviewing
Yes No
YYeess NNoo
C O P
Y
Type
Type
Type
Holmes Beach Police Department20170719
19
MISC BRANDS AND SIZES
1 FISHING REELS1
K2J733433
1
IN BOX
GLOBALSTAR2 SATELLITE PHONE1 GSP-1700
1
ORANGE PLASTIC W/ SCREW ON LID
3 GUN STORGE TUBE1
1
SMALL TAN/BRN RECT WOOD STOOL
4 STOOL1
10
CARDS
5 LATENT PRINTS1
0
V
V
V
V
0
0
0
0
S
Z
S
H
Z
5,000.00
1,000.00
50.00
50.00
0.00
1
1
1
8
1
01
6,100.00
0.00
DET
322
SGT.COPEMAN
OGLINE
307
1
BURGLARY MOORE BOBBY L
V
TH
EF
TA
DM
A. Auto Accessory/PartsB. BicycleC. Camera/Photo EquipmentD. Drug
T. TV/Video/VCRU. Currency/NegotiableV. Credit Card/Non-NegotiableW. Boat MotorX. Structure
Property TypeO. Office EquipmentP. Art/CollectionQ. Computer EquipmentR. Radio/StereoS. Sports Equipment
E. Equipment/Tool.F. Food/Liquor/ConsumableG. GunH. Household Appliance/GoodsI. Plant/Citrus
J. Jewelry/Precious MetalK. Clothing/FurL. LivestockM. Musical InstrumentN. Construction Machinery
Date of Supplement
Original Date Reported Primary Offense Description Victim #1 Name (Last, First, Middle)
Agency Report Number
1. Original2. SupplementPROPERTY REPORT
Y. Farm EquipmentZ. Miscellaneous
PR
OP
.D
ET
AIL
/N
AR
R.
CO
DE
S
09. From Vehicle10. Extortion
Theft Type Codes
04. Pocket Picking05. Purse Snatching
06. Embezzlement07. From Coin Oper. Machine
08. From PublicAccess Building
11. By Computer12. Fraud
99. Other00. N/A01. Burglary
02. Robbery03. Shoplifting
Theft Type
A - ArresteeO - Other
1. Stolen2. Recovered
V - VictimS - Suspect
5. Lost6. Found
Person Codes Status Codes
3. Stolen and Recovered4. Recovered for Other Jurisdiction
2. Criminal Mischief3. During other Offense
7. Safekeeping8. Evidence/Seized
9. Other9. Other
Damage Codes
0. N/A1. Arson
PR
OP
ER
TY
Serial Number
NameItem #Code Person Status Damage Property Type Quantity Brand Model Name/Number
Owner Applied Number Description (Size, Color, Caliber, Barrel Length, Etc. )
Value Value Recovered Date Recovered SCIC/NCIC
PropertyStolen
PropertyRecovered
Change in PropertyStolen Value
Change in PropertyRecovered Value
Activity Type Unit
Activity Description Quantity Unit
P. PossessS. SellB. BuyT. Traffic
R. SmuggleD. DeliverE. UseK. Dispense/Distribute
M. Manufacture/Produce/CultivateZ. Other
A. AmphetamineB. BarbiturateC. CocaineE. Heroin
H. HallucinogenM. MarijuanaO. Opium/DerivativeP. Paraphernalia/Equipment
S. SyntheticU. UnknownZ. Other
1. Gram2. Milligram3. Kilogram4. Ounce
5. Pound6. Ton7. Liter8. Milliliter
Estimated Street Value
TO
TA
LS
CO
DE
SD
RU
GS
PR
OP
ER
TY
Serial Number
NameItem #Code Person Status Damage Property Type Quantity Brand Model Name/Number
Owner Applied Number Description (Size, Color, Caliber, Barrel Length, Etc. )
Value Value Recovered Date Recovered SCIC/NCIC
PR
OP
ER
TY
Serial Number
NameItem #Code Person Status Damage Property Type Quantity Brand Model Name/Number
Owner Applied Number Description (Size, Color, Caliber, Barrel Length, Etc. )
Value Value Recovered Date Recovered SCIC/NCIC
PR
OP
ER
TY
Serial Number
NameItem #Code Person Status Damage Property Type Quantity Brand Model Name/Number
Owner Applied Number Description (Size, Color, Caliber, Barrel Length, Etc. )
Value Value Recovered Date Recovered SCIC/NCIC
PR
OP
ER
TY
Serial Number
NameItem #Code Person Status Damage Property Type Quantity Brand Model Name/Number
Owner Applied Number Description (Size, Color, Caliber, Barrel Length, Etc. )
Value Value Recovered Date Recovered SCIC/NCIC
Activity Description Quantity Unit Estimated Street Value
Activity Description Quantity Unit Estimated Street Value
AD
MIN
IST
RA
TIV
E
ID. Number(s)/Locator code Unit
DateID. Number Routed To Referred To Assigned To
Officer(s) Reporting Date
By
of
PagePage
Officer Reviewing (If Applicable)
Signature of Officer Reviewing
Signature of Officer Reporting
9. Dose Unit/Item
__/__/____
08/28/2017
__/__/____
__/__/____
__/__/____
__/__/____
08/28/2017
08/28/2017
__/__/____
USA Rev. 01/21/2003
C O P
Y
Holmes Beach Police DepartmentFL0410400 20170719
1 1
DET
OGLINE
SGT.COPEMAN 307
322
Fa I RESPONDED TO A REPORT OF A BURGLARY PAST AT LISTED LOCATION. UPON ARRIVAL, I MET WITH THE
VICTIM, BOBBY MOORE, WHO INFORMED ME HE WAS LAST THERE ON 8/14/2017 AND LEFT AROUND 1500 HOURS. HE
SAID HE AND HIS WIFE CAME BACK YESTERDAY AROUND NOON AND FOUND HIS SHOTGUN HANGING IN THE MASTER
BATHROOM ON A HOOK INSTEAD OF IN AN ORANGE WATERPROOF CASE HE KEPT IT IN WHILE HE STORED IT IN THE
CLOSET. HE SAID THE CASE WAS USED FOR TRANSPORTING THE SHOTGUN, A MOSSBERG MODEL 510 WITH PISTOL GRIP,
WHILE ON ONE OF HIS BOATS. HE SAID IT DID NOT HIT HIM THAT HE WAS THE VICTIM OF A BURGLARY UNTIL HE
JUST WENT INTO THE GARAGE AND FOUND 18 REELS TAKEN OFF OF 18 FISHING POLES. HE SAID HE THEN STARTED
LOOKING AROUND AND FOUND HIS NEW SATELLITE PHONE MISSING FROM THE CLOSET, WHERE HE KEPT IT ABOVE WHERE
THE SHOTGUN WAS KEPT. HE SAID HE FOUND A SMALL RECTANGULAR WOODEN STOOL HE USED IN HIS BATHROOM
MISSING, ALSO.
BASED UPON THE VICTIM'S STATEMENTS, I DETERMINED THE SUSPECT(S) ARMED THEMSELVES WITH THE SHOTGUN
AT SOME POINT BUT DID NOT REMOVE IT FROM THE PREMISES. AN INITIAL SEARCH OF THE PERIMETER DID NOT
REVEAL A POINT OF ENTRY/EXIT BUT I EVENTUALLY FOUND PRY MARKS ON TOP OF THE BOLT FOR THE DOOR HANDLE
TO THE SIDE (WEST) GARAGE DOOR. THE DEADBOLT WOULD NOT ENGAGE DUE TO THE DOOR WARPING AND I COULD SEE
FRESH MARKS ON TOP OF THE DOOR HANDLE BOLT BETWEEN THE DOOR AND JAMB INDICATING SOMEONE USED A FLAT
AND SHARP INSTRUMENT, LIKE A SMALL POCKET KNIFE, TO REACH IN BEHIND THE BOLT TO POP THE DOOR OPEN.
THE VICTIM AND I THEN CHECKED HIS TWO BOATS AND WE FOUND ONE OF THEM HAD BEEN ENTERED. BOTH BOATS
WERE ON LIFTS OUT BACK ON THE CANAL AND I CONFIRMED ENTRY WAS MADE TO HIS 33 FT GRADY WHITE, MODEL 330
EXPRESS, FL2765PF, BECAUSE THE CABIN DOOR WAS OPEN AND WAS KEPT CLOSED. I ALSO NOTICED THE LADDER TO
THE RIGHT OF THE MOTORS, IF YOU WERE AT THE BACK OF THE BOAT, WAS DOWN AND THE VICTIM SAID IT WAS
USUALLY KEPT UP. WITH THAT, I DETERMINED IT WAS A STRONG POSSIBILITY THE SUSPECT(S) APPROACHED THE
RESIDENCE BY BOAT, AS THERE WAS NO REASON FOR THE LADDER TO HAVE BEEN PULLED DOWN UNLESS IT WAS
ENTERED FROM ANOTHER BOAT ON THE WATER. I THEN FOUND A POLE THAT HAD THE REEL STRIPPED OFF OF IT IN
THE CABIN, BRINGING THE TOTAL TO 19 REELS TAKEN FROM THE VICTIM.
I WAS UNABLE TO LOCATE ANY PHYSICAL EVIDENCE FROM THE RESIDENCE BUT DID OBTAIN 10 LATENT PRINT
CARDS FROM THE BOAT. I LATER PLACED THE LATENT PRINT CARDS INTO THE EVIDENCE BOX AT THE STATION. I
ALSO HAD DISPATCH OPERATOR #: 325 ENTER THE PHONE INTO THE FCIC/NCIC STOLEN FILES. I CHECKED THE PAWN
SHOP DATABASE FOR LOCAL AND SURROUNDING COUNTIES' PAWNS OF MULTIPLE REELS AND THE SATELLITE PHONE WITH
NEGATIVE RESULTS. THERE WERE NO OTHER LEADS TO FOLLOW UP ON NOR ANY OTHER PHYSICAL EVIDENCE TO
COLLECT.
NA
RR
AT
IVE
Original Date Reported
NARRATIVE CONTINUATION
Case ReferenceAD
M
Date of Supplement Agency ORI Number
1. Offense
2. Arrest
Juvenile
Warn/Dismiss
1. Original
2. Supplement
Agency Report Number
Case Status
Routed To Referred To
Related Report Number(s)
Unit
of
Page
Number ArrestedClearance Type
Exception Type 2. Arrest on Primary OffenseSecondary Offense Without Prosecution
3. Death of Offender4. V / W Refused to Cooperate
3.Unfounded
Page
Date
5. Prosecution Declined6. Juvenile/No Custody1.Extradition Declined
1.Arrest2.Exceptional
OBTS Number
Date Cleared
ByAssigned To
AD
MIN
IST
RA
TIV
E
A-AdultJ-Juvenile
Date
Name of Officer Reporting
Officer Reviewing (If Applicable) I.D. Number
I.D. Number/Locator CodeReport Contains
Arrest Number
__/__/____
08/28/2017
08/28/2017
__/__/____
__/__/____
USA Rev. 01/21/2003
Signature of Officer Reporting
Signature of Officer Reviewing
C O P
Y
Holmes Beach Police Department
FL0410400
26
00
1529
1 1 1 0 0
STATE
JOSE PEREZ
5412 25TH ST. UNIT B 34207BRADENTON
LABORER
P625425874080
SHIRT AND JEANS
507 175
1529 1529 1539
1529 1529
29
20170721
MEXICO
OF FLORIDA
DRIVERS LICENSE
Tue Tue
Tue
1V 3
PEREZ-MARQUEZ JOSE ERNESTO1 2A
MW BRO BLK
FL
S S
LT MED M
FL
34 2B 90004 322CDRIVERS LIC
___-_______
___-__-____
___ ___-____
___-_______
___ ___-____
___-_______
___ ___-____
34217 W80
KING FISH
MAANTEE AVE. HOLMES BEACH700
0 0
I RAN TAG (0625TJ) THROUGH FCIC/NCIC. THE RETURN DISPLAYED THAT REGISTERED OWNER DID NOT HAVE AVALID LICENSE. I INITIATED TRAFFIC STOP AND WAS GIVEN CREDENTIALS EXCEPT A LICENSE. SUBJECT SAID HEDIDN'T HAVE A LICENSE AND HAS A LAWYER TO GET ONE. SUBJECT'S VEHICLE REGISTRATION HAS P625425874080 ASADMINISTRATIVE NUMBER. BUT, HOWEVER A D.A.V.I.D. QUERY STATED THAT HE HAS NUMBER (P620420874080) UNDERTHE SHORTENED NAME JOSE PEREZ; ASSIGNED TO HIM. THE HISTORY OF THAT STATED THAT SUBJECT HAS BEENPREVIOUSLY CITED FOR DWLS. SUMMONS ISSUED IN LIEU OF ARREST.
11
JASON HIGGINS
SGT.COPEMAN 307
331
1
EV
EN
TD
AT
AN
AR
RA
TIV
ES
US
PE
CT
00. N/A01. Gunshot02. Stabbed
CO
DE
SA
DM
A-Attempted
C-Committed
A-Attempted
C-Committed
Area
Type of Weapon
01. Residence Single
02. Apartment/Condo
03. Residence-Other
04. Hotel/Motel
Time (mil)
Time Dispatched (mil)
Primary Offense Description
21. Employer22. Landlord/Tenant23. Acquaintance99. Other Known
5. Ordinance
9. Other
Zone
)
Agency Report Number
3. Misdemeanor
4. Traffic Misdemeanor
OFF/INC
# 2
OFF/INC
# 1
Business Name/Area Identifier
District
NCIC/UCR Code
2. No
Location Type
V/W Code
# Victims
00. N/A01. Handgun
05. Knife/CuttingInstrument
06. Blunt Object
07. Hands/Fist/Feet08. Poison09. Explosives
10. Fire/Incendiary11. Threat/Intimidation12. Simulated Weapon
V - VictimW - WitnessC - Reporting Person
O - Other
Race
N - N/AM - MaleF - FemaleU - Unknown
Residence Type
0. N/A1. City2. County
Extent of InjuryResidence Status
03. Laceration04. Unconscious05. Poss. Broken Bones06. Poss. Internal Injury
Victim Relationship To Offender07. Loss of Teeth08. Burns09. Abrasions/Bruises99. Other
06. Parent07. Brother/Sister08. Child09. Step-Parent
10. Step-Child11. In-Law12. Other Family13. Student
V/W Code # Name (Last, First, Middle or Business) Residence Phone
Business Phone
Race Sex Injury Type(s) Relationship Ethnicity Will Victim prefer charge?
Synopsis of Involvement
Residence Phone
Business Phone
Juvenile
Occupation
Sex Date of Birth Height Weight Eye Color Hair Length Hair Style
Nickname/Street Name Place of Birth
Social Security Number
SCIC/NCIC
Employer/School
Teeth Speech/Voice Special Identifiers
Original DayReported
Date Time (mil) Time Arrived (mil) Time Completed (mil)
1. Felony
2. Traffic Felony To
Time (mil)
(-
Type
30. Other Mobile
99. Other
15. Industrial/Mfg.
16. Storage
17. Gov't/Public Bldg.
18. School/University
19. Jail/Prison
20. Religious Bldg.
21. Airport
22. Bus/Rail Terminal
23. Construction Site
24. Other Structure
25. Parking Lot/Garage
26. Highway/Roadway
27. Park/Woodlands/Field
28. Lake/Waterway
29. Motor Vehicle
10. Dept/Discount Store
11. Specialty Store
12. Drug Store/Hospital
13. Bank/Financial Inst.
14. Commercial/Office Bldg.
Suspect Code
Incident Location (Street Number, Street, Apt,)
Scars/Marks/Tatoos (Location/Describe)
0. N/A
1. Occupied
E-EscapeeZ-Other
From
Date of Supplement
- (
17. Friend18. Neighbor19. Sitter/Day Care20. Employee
V/W Code # Name (Last, First, Middle or Business) Residence Phone
Business Phone
Race Sex Injury Type(s) Relationship Ethnicity Will Victim prefer charge?
Synopsis of Involvement
V. Type
OFF/INC Indicator
OBTS Number (Arrested)Other I.D. NumberImmigration and Naturalization Number
Incident Type Incident: Day Date
2. Unoccupied
3. Abandoned
05. Convenience Store
06. Gas Station
07. Liquor Sales
08. Bar/Nightclub
09. Supermarket
DateDay
0. N/A
1. Yes
Forced Entry Occupancy
Statute Violation Number - Chapter, Section, SubDescriptionType
Hair ColorRace
Facial HairBuildComplexion
Driver's License Number/State
Address
Code
Maiden Name
Name (Last, First, Middle)
Extent of InjuryRes. StatusRes. Type
ZipStateCity
Extent of InjuryRes. StatusRes. Type
ZipStateCity
13. Drugs88. Unknown99. Other
Grid
Victim Type
0. N/A1. Juvenile2. L.E. Officer3. Adult
4. Business5. Government6. Church9. Other
Sex
I - American IndianO - Oriental/AsianU - Unknown
N - N/AW - WhiteB - Black
3. Florida4. Out-of-State
0. N/A1. Full Year2. Part Year3. Non-Resident
0. None1. Minor2. Serious3. Fatal
14. Teacher15. Child of Boy/Girl
Friend16. Boy/Girl Friend
03. Spouse04. Ex-Spouse05. Co-Habitant
00. N/A01. Undetermined02. Stranger
Injury Type
Clothing (Describe)
ZipStateCity
02. Rifle03. Shotgun04. Firearm
Susp. #
VIC
TIM
/W
ITN
ES
SV
ICT
IM/W
ITN
ES
S
# Prem. Ent.
S-SuspectA-Arrestee
Dom. Violence
Dom. Violence
ZipCity
# OFF/INC. # Offenders # Veh. Stolen
1.#12.#2
3.Both
)
Age
Date of Birth Age
Date of Birth Age
Address (Street, Apt. Number)
Other Contact Info. (Time Available, Interpreter, etc.)
Address (Street, Apt. Number)
Other Contact Info. (Time Available, Interpreter, etc.)
Last Known Address (Street, Apt. Number)
V. TypeOFF/INC Indicator
If V/W Code isV, W or C
Fill in this Line
1.#12.#2
3.Both
OFF/INC Indicator
If V/W Code isV, W or C
Fill in this Line
1.#12.#2
3.Both
Person/Unit Notified
Case Status
Time
Routed To Referred
Related Report Number(s)
Unit
of
Page
Number ArrestedClearance Type
Exception Type 2. Arrest on Primary OffenseSecondary Offense Without Prosecution
3. Death of Offender4. V / W Refused to Cooperate
3.Unfounded
Page
Date
5. Prosecution Declined6. Juvenile/No Custody1.Extradition Declined
1.Arrest2.Exceptional
Jail Number
OBTS Number
Date Cleared
ByAssigned To
AD
MIN
IST
RA
TIV
E
A-AdultJ-Juvenile
Date
Name of Officer Reporting
Officer Reviewing (If Applicable) I.D. Number
I.D. Number/Locator Code
1. Original2. Supplement
Juvenilein Report
JuvenileWarn/Dismiss
1
__/__/____
08/29/2017
08/29/2017 08/29/2017
__/__/____
08/29/2017
__/__/____
11/08/1987
Signature of Officer Reporting
Signature of Officer Reviewing
Yes No
YYeess NNoo
12 NOFFENSE-INCIDENT REPORTGangRelated
C O P
Y
Holmes Beach Police Department
FL0410400
26
00
1549
01 01 01 00 00
CITY OF HOLMES BEACH
5801 MARINA DR HOLMES BEACH 34217
846 SW 31st TER 33991CAPE CORAL
W435778632130
510 160
1549 1549 1605
1545 1550
54
20170722
MD
TRAFFIC STOP
Tue Tue
Tue
2 NN 0 0 0 00 0000
1V 5
FL
WALTMAN ROBERT THOMAS1 2A
MW BRO BRO
FL
M S
LT THN
FL
34 2a 90004 322CDRIVERS LIC
708-5800941
___-__-____
___ ___-____
___-_______
___ ___-____
___-_______
239 321-0662
34217EAST BAY DR HOLMES BEACH3900
0 0
I STOPPED A BLUE KIA FL TAG 296KZP AFTER RANDOMLY RUNNING TAGS AND GETTING A HIT ON THE REGISTEREDOWNER, ROBERT WALTMAN, SHOWING A TOTAL OF 4 SUSPENSIONS ON HIS DRIVER LICENSE, 2 FOR DUI. I ISSUED UTCSUMMONS A2H5Y2E FOR DWLS W/ KNOWLEDGE AFTER HE CONFIRMED HE KNEW HIS DL WAS SUSPENDED. I TURNED SIGNEDCOURT COPY IN FOR RECORDS.
OGLINE
SGT.COPEMAN 307
322
1
EV
EN
TD
AT
AN
AR
RA
TIV
ES
US
PE
CT
00. N/A01. Gunshot02. Stabbed
CO
DE
SA
DM
A-Attempted
C-Committed
A-Attempted
C-Committed
Area
Type of Weapon
01. Residence Single
02. Apartment/Condo
03. Residence-Other
04. Hotel/Motel
Time (mil)
Time Dispatched (mil)
Primary Offense Description
21. Employer22. Landlord/Tenant23. Acquaintance99. Other Known
5. Ordinance
9. Other
Zone
)
Agency Report Number
3. Misdemeanor
4. Traffic Misdemeanor
OFF/INC
# 2
OFF/INC
# 1
Business Name/Area Identifier
District
NCIC/UCR Code
2. No
Location Type
V/W Code
# Victims
00. N/A01. Handgun
05. Knife/CuttingInstrument
06. Blunt Object
07. Hands/Fist/Feet08. Poison09. Explosives
10. Fire/Incendiary11. Threat/Intimidation12. Simulated Weapon
V - VictimW - WitnessC - Reporting Person
O - Other
Race
N - N/AM - MaleF - FemaleU - Unknown
Residence Type
0. N/A1. City2. County
Extent of InjuryResidence Status
03. Laceration04. Unconscious05. Poss. Broken Bones06. Poss. Internal Injury
Victim Relationship To Offender07. Loss of Teeth08. Burns09. Abrasions/Bruises99. Other
06. Parent07. Brother/Sister08. Child09. Step-Parent
10. Step-Child11. In-Law12. Other Family13. Student
V/W Code # Name (Last, First, Middle or Business) Residence Phone
Business Phone
Race Sex Injury Type(s) Relationship Ethnicity Will Victim prefer charge?
Synopsis of Involvement
Residence Phone
Business Phone
Juvenile
Occupation
Sex Date of Birth Height Weight Eye Color Hair Length Hair Style
Nickname/Street Name Place of Birth
Social Security Number
SCIC/NCIC
Employer/School
Teeth Speech/Voice Special Identifiers
Original DayReported
Date Time (mil) Time Arrived (mil) Time Completed (mil)
1. Felony
2. Traffic Felony To
Time (mil)
(-
Type
30. Other Mobile
99. Other
15. Industrial/Mfg.
16. Storage
17. Gov't/Public Bldg.
18. School/University
19. Jail/Prison
20. Religious Bldg.
21. Airport
22. Bus/Rail Terminal
23. Construction Site
24. Other Structure
25. Parking Lot/Garage
26. Highway/Roadway
27. Park/Woodlands/Field
28. Lake/Waterway
29. Motor Vehicle
10. Dept/Discount Store
11. Specialty Store
12. Drug Store/Hospital
13. Bank/Financial Inst.
14. Commercial/Office Bldg.
Suspect Code
Incident Location (Street Number, Street, Apt,)
Scars/Marks/Tatoos (Location/Describe)
0. N/A
1. Occupied
E-EscapeeZ-Other
From
Date of Supplement
- (
17. Friend18. Neighbor19. Sitter/Day Care20. Employee
V/W Code # Name (Last, First, Middle or Business) Residence Phone
Business Phone
Race Sex Injury Type(s) Relationship Ethnicity Will Victim prefer charge?
Synopsis of Involvement
V. Type
OFF/INC Indicator
OBTS Number (Arrested)Other I.D. NumberImmigration and Naturalization Number
Incident Type Incident: Day Date
2. Unoccupied
3. Abandoned
05. Convenience Store
06. Gas Station
07. Liquor Sales
08. Bar/Nightclub
09. Supermarket
DateDay
0. N/A
1. Yes
Forced Entry Occupancy
Statute Violation Number - Chapter, Section, SubDescriptionType
Hair ColorRace
Facial HairBuildComplexion
Driver's License Number/State
Address
Code
Maiden Name
Name (Last, First, Middle)
Extent of InjuryRes. StatusRes. Type
ZipStateCity
Extent of InjuryRes. StatusRes. Type
ZipStateCity
13. Drugs88. Unknown99. Other
Grid
Victim Type
0. N/A1. Juvenile2. L.E. Officer3. Adult
4. Business5. Government6. Church9. Other
Sex
I - American IndianO - Oriental/AsianU - Unknown
N - N/AW - WhiteB - Black
3. Florida4. Out-of-State
0. N/A1. Full Year2. Part Year3. Non-Resident
0. None1. Minor2. Serious3. Fatal
14. Teacher15. Child of Boy/Girl
Friend16. Boy/Girl Friend
03. Spouse04. Ex-Spouse05. Co-Habitant
00. N/A01. Undetermined02. Stranger
Injury Type
Clothing (Describe)
ZipStateCity
02. Rifle03. Shotgun04. Firearm
Susp. #
VIC
TIM
/W
ITN
ES
SV
ICT
IM/W
ITN
ES
S
# Prem. Ent.
S-SuspectA-Arrestee
Dom. Violence
Dom. Violence
ZipCity
# OFF/INC. # Offenders # Veh. Stolen
1.#12.#2
3.Both
)
Age
Date of Birth Age
Date of Birth Age
Address (Street, Apt. Number)
Other Contact Info. (Time Available, Interpreter, etc.)
Address (Street, Apt. Number)
Other Contact Info. (Time Available, Interpreter, etc.)
Last Known Address (Street, Apt. Number)
V. TypeOFF/INC Indicator
If V/W Code isV, W or C
Fill in this Line
1.#12.#2
3.Both
OFF/INC Indicator
If V/W Code isV, W or C
Fill in this Line
1.#12.#2
3.Both
Person/Unit Notified
Case Status
Time
Routed To Referred
Related Report Number(s)
Unit
of
Page
Number ArrestedClearance Type
Exception Type 2. Arrest on Primary OffenseSecondary Offense Without Prosecution
3. Death of Offender4. V / W Refused to Cooperate
3.Unfounded
Page
Date
5. Prosecution Declined6. Juvenile/No Custody1.Extradition Declined
1.Arrest2.Exceptional
Jail Number
OBTS Number
Date Cleared
ByAssigned To
AD
MIN
IST
RA
TIV
E
A-AdultJ-Juvenile
Date
Name of Officer Reporting
Officer Reviewing (If Applicable) I.D. Number
I.D. Number/Locator Code
1. Original2. Supplement
Juvenilein Report
JuvenileWarn/Dismiss
1
__/__/____
08/29/2017
08/29/2017 08/29/2017
__/__/____
08/29/2017
__/__/____
06/13/1963
Signature of Officer Reporting
Signature of Officer Reviewing
Yes No
YYeess NNoo
12 NOFFENSE-INCIDENT REPORTGangRelated
C O P
Y
502FW 1904/06/1998
FL0410400
26
00
0900
01 01 01 00 00
WOODARD
707 63RD AVE DR W 34207BRADENTON
W363733986260
Holmes Beach Police Department
0900 0900 0914
20170723
RHIANNON MARIE
DRIVERS LICENSE
01
Thu
01 STATE OF FLORIDA
2 NN
V 0
2A
0 0 0 00 0000
FL
LT MED
FL
01
PATROL
1 ACA
J. PIERCE
SGT. M. PILATO 306
201 2 9000324CDRIVERS LIC
___-_______
___-__-____
___ ___-____
___-_______
___ ___-____
___-_______
___ ___-____
34217GULF DR HOLMES BEACH6400
0
4
1
309
1
N2 1
00. N/A
01. Gunshot
02. Stabbed
OFF/INC Indicator
EV
EN
TD
AT
AN
AR
RA
TIV
ES
US
PE
CT
CO
DE
SA
DM
A-AttemptedC-Committed
A-AttemptedC-Committed
Area
Type of Weapon
01. Residence Single02. Apartment/Condo03. Residence-Other04. Hotel/Motel
Time (mil)
GangRelated
Time Dispatched (mil)
Primary Offense Description
21. Employer
22. Landlord/Tenant
23. Acquaintance
99. Other Known
5. Ordinance9. Other
Zone
)
Agency Report Number
3. Misdemeanor4. Traffic Misdemeanor
OFF/INC# 1
Business Name/Area Identifier
District
NCIC/UCR Code
2. No
Location Type
V/W Code
# Victims
00. N/A01. Handgun
05. Knife/CuttingInstrument
06. Blunt Object
07. Hands/Fist/Feet08. Poison09. Explosives
10. Fire/Incendiary11. Threat/Intimidation12. Simulated Weapon
V - Victim
W - Witness
C - Reporting Person
O - Other
Race
N - N/A
M - Male
F - Female
U - Unknown
Residence Type
0. N/A
1. City
2. County
Extent of InjuryResidence Status
03. Laceration
04. Unconscious
05. Poss. Broken Bones
06. Poss. Internal Injury
Victim Relationship To Offender07. Loss of Teeth
08. Burns
09. Abrasions/Bruises
99. Other
06. Parent
07. Brother/Sister
08. Child
09. Step-Parent
10. Step-Child
11. In-Law
12. Other Family
13. Student
Residence Phone
Business Phone
Juvenille
Occupation
Height Weight Eye Color Hair Length Hair Style
Nickname/Street Name Place of Birth
Social Security Number
SCIC/NCIC
Employer/School
Teeth Speech/Voice Special Identifiers
Original DayReported
Date Time (mil) Time Arrived (mil) Time Completed (mil)
1. Felony2. Traffic Felony To
Time (mil)
(-
Type
15. Industrial/Mfg.16. Storage17. Gov't/Public Bldg.18. School/University19. Jail/Prison
20. Religious Bldg.21. Airport22. Bus/Rail Terminal23. Construction Site24. Other Structure
25. Parking Lot/Garage26. Highway/Roadway27. Park/Woodlands/Field28. Lake/Waterway29. Motor Vehicle
10. Dept/Discount Store11. Specialty Store12. Drug Store/Hospital13. Bank/Financial Inst.14. Commercial/Office Bldg.
Suspect Code
Incident Location (Street Number, Street, Apt,)
Scars/Marks/Tatoos (Location/Describe)
OFFENSE-INCIDENT REPORT
0. N/A1. Occupied
E-EscapeeM-Missing
From
Date of Supplement
- (
17. Friend
18. Neighbor
19. Sitter/Day Care
20. Employee
OFF/INC Indicator
OBTS Number (Arrested)Other I.D. NumberImmigration and Naturalization Number
Incident Type Incident: Day Date
2. Unoccupied3. Abandoned
05. Convenience Store06. Gas Station07. Liquor Sales08. Bar/Nightclub09. Supermarket
DateDay
0. N/A1. Yes
Forced Entry Occupancy
Statute Violation Number - Chapter, Section, SubDescriptionType
Hair Color
Facial HairBuildComplexion
Driver's License Number/State
Address
Code
Maiden Name
Name (Last, First, Middle)
13. Drugs88. Unknown99. Other
Grid
Victim Type0. N/A
1. Juvenile
2. L.E. Officer
3. Adult
4. Business
5. Government
6. Church
9. Other
Sex
I - American Indian
O - Oriental/Asian
U - Unknown
N - N/A
W - White
B - Black
3. Florida
4. Out-of-State
0. N/A
1. Full Year
2. Part Year
3. Non-Resident
0. None
1. Minor
2. Serious
3. Fatal
14. Teacher
15. Child of Boy/Girl
Friend
16. Boy/Girl Friend
03. Spouse
04. Ex-Spouse
05. Co-Habitant
00. N/A
01. Undetermined
02. Stranger
Injury Type
Clothing (Describe)
ZipStateCity
02. Rifle03. Shotgun04. Firearm
# Prem. Ent.
S-SuspectA-Arrestee
ZipCity
# OFF/INC. # Offenders # Veh. Stolen
1.#12.#2
3.Both
)
If V/W Code isV, W or C
Fill in this LineOFF/INC Indicator
V/W Code # Name (Last, First, Middle or Business) Residence Phone
Business Phone
Race Sex Injury Type(s) Relationship Ethnicity Will Victim prefer charge?
Synopsis of Involvement
V. Type
V/W Code # Name (Last, First, Middle or Business) Residence Phone
Business Phone
Race Sex Injury Type(s) Relationship Ethnicity Will Victim prefer charge?
Synopsis of Involvement
V. Type
Extent of InjuryRes. StatusRes. Type
ZipStateCity
Extent of InjuryRes. StatusRes. Type
ZipStateCity
VIC
TIM
/W
ITN
ES
SV
ICT
IM/W
ITN
ES
S
Dom. Violence
Dom. Violence
1.#12.#2
3.Both
1.#12.#2
3.Both
Date of Birth Age
Date of Birth Age
If V/W Code isV, W or C
Fill in this Line
Address (Street, Apt. Number)
Other Contact Info. (Time Available, Interpreter, etc.)
Address (Street, Apt. Number)
Other Contact Info. (Time Available, Interpreter, etc.)
Last Known Address (Street, Apt. Number)
OFF/INC# 2
R-Rec. MissingZ-other
Person/Unit Notified
Case Status
Time
Routed To Referred To
Related Report Number(s)
Unit
of
Page
Number ArrestedClearance Type
Exception Type2. Arrest on Primary Offense
Secondary Offense Without Prosecution3. Death of Offender4. V / W Refused to Cooperate
3.Unfounded
Page5. Prosecution Declined6. Juvenile/No Custody1.Extradition Declined
1.Arrest2.Exceptional
Jail Number
OBTS Number
Date Cleared
AD
MIN
IST
RA
TIV
E
A-AdultJ-Juvenile
Date
Name of Officer Reporting
Officer Reviewing (If Applicable) I.D. Number
I.D. Number/Locator Code
By DateAssigned To
30. Other Mobile99. Other
Susp.#
JuvenileWarn/Dismiss:
1. Original2. Supplement:
Juvenilein Report:
__/__/____
08/31/2017
08/31/2017
__/__/____
USA Rev. 01/23/2003
Thu Thu08/31/2017 08/31/2017
Sex Date of BirthRace Age
08/31/2017
Yes No
YYeess NNoo
0
Signature of Officer Reporting
Signature of Officer Reviewing
C O P
Y
Holmes Beach Police Department
DRIVERS LICENSE
2 1
01
PATROL
1 ACA
J. PIERCE
SGT. M. PILATO 306
309
ON 08-31-17 WHILE ON ROUTINE PATROL I OBSERVED A WHITE HONDA BEARING FL TAG# EGWA21 TRAVELING NORTH ON
GULF DR. UPON RUNNING THE TAG THROUGH FCIC/NCIC THE DRIVER/REGISTERED OWNER (RHIANNON MARIE WOODARD)
HAD A SUSPENDED LICENSE AS OF 08/24/2017 FR-SUSP NON-JUDGEMENT SUSPENSION. I CONDUCTED A TRAFFIC STOP
ON THE VEHICLE AND SPOKE WITH THE DRIVER (RHIANNON MARIE WOODARD). I ADVISED HER THAT HER DRIVERS
LICENSE HAD A CURRENT SUSPENSION ON IT. SHE ADVISED SHE WAS HAVING A PROBLEM WITH HER INSURANCE AND
THAT IT HAD LAPSED. I ISSUED WOODARD A SUMMONS FOR DRIVING ON A SUSPENDED LICENSE (FR SUSPENSION).
CITATION:A2H5Y3E
NA
RR
AT
IVE
Original Date Reported
NARRATIVE CONTINUATION
Case ReferenceAD
M
Date of Supplement Agency ORI Number
1. Offense
2. Arrest
Juvenile
Warn/Dismiss
1. Original
2. Supplement
Agency Report Number
Case Status
Routed To Referred To
Related Report Number(s)
Unit
of
Page
Number ArrestedClearance Type
Exception Type 2. Arrest on Primary OffenseSecondary Offense Without Prosecution
3. Death of Offender4. V / W Refused to Cooperate
3.Unfounded
Page
Date
5. Prosecution Declined6. Juvenile/No Custody1.Extradition Declined
1.Arrest2.Exceptional
OBTS Number
Date Cleared
ByAssigned To
AD
MIN
IST
RA
TIV
E
A-AdultJ-Juvenile
Date
Name of Officer Reporting
Officer Reviewing (If Applicable) I.D. Number
I.D. Number/Locator CodeReport Contains
Arrest Number
__/__/____
08/31/2017
08/31/2017
__/__/____
08/31/2017
USA Rev. 01/23/2003
20170723FL0410400
Signature of Officer Reviewing
Signature of Officer Reporting
C O P
Y
Holmes Beach Police Department
FL0410400
26
00
1001
01 01 01 00 00
STATE OF FLORIDA
604 58TH AVE DRIVE EAST 34203BRADENTON
CLEANER
NONE
506
1001 1001 1050
1000 1001
38
20170724
UNKNOWN
CRIM TRAFFIC
Thu Thu
Thu
2 NN 0 0 0 00 0000
1V 5
CONTRERAS MARIA1 2A
FW
FL
FL
03 1 90004 322CDRIVERS LIC
___-_______
___-__-____
___ ___-____
___-_______
___ ___-____
___-_______
941 580-4402
34217MARINA DR HOLMES BEACH8100
0 1
WHILE ON PATROL, I OBSERVED THE VEHICLE DRIVING NORTH ON GULF DR. I RAN THE PLATE AND THE REGISTEREDOWNER. UPON GETTING THE RETURN, THE REGISTERED OWNER DID NOT HAVE A DRIVERS LICENSE. ON ANINVESTIGATIVE STOP, I MET WITH THE DEFENDANT WHO STATED THAT SHE DID NOT HAVE A DRIVERS LICENSE. UPONGETTING AN INTERPRETER TO COMMUNICATE, SHE ADVISED THAT SHE HAS NEVER HAD A DRIVERS LICENSE. SHE WASISSUED A NOTICE TO APPEAR FOR THE VIOLATION AND SHE DID NOT HAVE A VALID INSURANCE CARD AND WAS ISSUEDA UTC. (A2H5Y5E)SHE WAS RELEASED ON SCENE AND HER BOSS PARKED HER VEHICLE IN A PARKING LOT. NFI
01
PATROL
1 ACA
SGT. M. PILATO
SGT. M. PILATO 306
306
1
EV
EN
TD
AT
AN
AR
RA
TIV
ES
US
PE
CT
00. N/A01. Gunshot02. Stabbed
CO
DE
SA
DM
A-Attempted
C-Committed
A-Attempted
C-Committed
Area
Type of Weapon
01. Residence Single
02. Apartment/Condo
03. Residence-Other
04. Hotel/Motel
Time (mil)
Time Dispatched (mil)
Primary Offense Description
21. Employer22. Landlord/Tenant23. Acquaintance99. Other Known
5. Ordinance
9. Other
Zone
)
Agency Report Number
3. Misdemeanor
4. Traffic Misdemeanor
OFF/INC
# 2
OFF/INC
# 1
Business Name/Area Identifier
District
NCIC/UCR Code
2. No
Location Type
V/W Code
# Victims
00. N/A01. Handgun
05. Knife/CuttingInstrument
06. Blunt Object
07. Hands/Fist/Feet08. Poison09. Explosives
10. Fire/Incendiary11. Threat/Intimidation12. Simulated Weapon
V - VictimW - WitnessC - Reporting Person
O - Other
Race
N - N/AM - MaleF - FemaleU - Unknown
Residence Type
0. N/A1. City2. County
Extent of InjuryResidence Status
03. Laceration04. Unconscious05. Poss. Broken Bones06. Poss. Internal Injury
Victim Relationship To Offender07. Loss of Teeth08. Burns09. Abrasions/Bruises99. Other
06. Parent07. Brother/Sister08. Child09. Step-Parent
10. Step-Child11. In-Law12. Other Family13. Student
V/W Code # Name (Last, First, Middle or Business) Residence Phone
Business Phone
Race Sex Injury Type(s) Relationship Ethnicity Will Victim prefer charge?
Synopsis of Involvement
Residence Phone
Business Phone
Juvenile
Occupation
Sex Date of Birth Height Weight Eye Color Hair Length Hair Style
Nickname/Street Name Place of Birth
Social Security Number
SCIC/NCIC
Employer/School
Teeth Speech/Voice Special Identifiers
Original DayReported
Date Time (mil) Time Arrived (mil) Time Completed (mil)
1. Felony
2. Traffic Felony To
Time (mil)
(-
Type
30. Other Mobile
99. Other
15. Industrial/Mfg.
16. Storage
17. Gov't/Public Bldg.
18. School/University
19. Jail/Prison
20. Religious Bldg.
21. Airport
22. Bus/Rail Terminal
23. Construction Site
24. Other Structure
25. Parking Lot/Garage
26. Highway/Roadway
27. Park/Woodlands/Field
28. Lake/Waterway
29. Motor Vehicle
10. Dept/Discount Store
11. Specialty Store
12. Drug Store/Hospital
13. Bank/Financial Inst.
14. Commercial/Office Bldg.
Suspect Code
Incident Location (Street Number, Street, Apt,)
Scars/Marks/Tatoos (Location/Describe)
0. N/A
1. Occupied
E-EscapeeZ-Other
From
Date of Supplement
- (
17. Friend18. Neighbor19. Sitter/Day Care20. Employee
V/W Code # Name (Last, First, Middle or Business) Residence Phone
Business Phone
Race Sex Injury Type(s) Relationship Ethnicity Will Victim prefer charge?
Synopsis of Involvement
V. Type
OFF/INC Indicator
OBTS Number (Arrested)Other I.D. NumberImmigration and Naturalization Number
Incident Type Incident: Day Date
2. Unoccupied
3. Abandoned
05. Convenience Store
06. Gas Station
07. Liquor Sales
08. Bar/Nightclub
09. Supermarket
DateDay
0. N/A
1. Yes
Forced Entry Occupancy
Statute Violation Number - Chapter, Section, SubDescriptionType
Hair ColorRace
Facial HairBuildComplexion
Driver's License Number/State
Address
Code
Maiden Name
Name (Last, First, Middle)
Extent of InjuryRes. StatusRes. Type
ZipStateCity
Extent of InjuryRes. StatusRes. Type
ZipStateCity
13. Drugs88. Unknown99. Other
Grid
Victim Type
0. N/A1. Juvenile2. L.E. Officer3. Adult
4. Business5. Government6. Church9. Other
Sex
I - American IndianO - Oriental/AsianU - Unknown
N - N/AW - WhiteB - Black
3. Florida4. Out-of-State
0. N/A1. Full Year2. Part Year3. Non-Resident
0. None1. Minor2. Serious3. Fatal
14. Teacher15. Child of Boy/Girl
Friend16. Boy/Girl Friend
03. Spouse04. Ex-Spouse05. Co-Habitant
00. N/A01. Undetermined02. Stranger
Injury Type
Clothing (Describe)
ZipStateCity
02. Rifle03. Shotgun04. Firearm
Susp. #
VIC
TIM
/W
ITN
ES
SV
ICT
IM/W
ITN
ES
S
# Prem. Ent.
S-SuspectA-Arrestee
Dom. Violence
Dom. Violence
ZipCity
# OFF/INC. # Offenders # Veh. Stolen
1.#12.#2
3.Both
)
Age
Date of Birth Age
Date of Birth Age
Address (Street, Apt. Number)
Other Contact Info. (Time Available, Interpreter, etc.)
Address (Street, Apt. Number)
Other Contact Info. (Time Available, Interpreter, etc.)
Last Known Address (Street, Apt. Number)
V. TypeOFF/INC Indicator
If V/W Code isV, W or C
Fill in this Line
1.#12.#2
3.Both
OFF/INC Indicator
If V/W Code isV, W or C
Fill in this Line
1.#12.#2
3.Both
Person/Unit Notified
Case Status
Time
Routed To Referred
Related Report Number(s)
Unit
of
Page
Number ArrestedClearance Type
Exception Type 2. Arrest on Primary OffenseSecondary Offense Without Prosecution
3. Death of Offender4. V / W Refused to Cooperate
3.Unfounded
Page
Date
5. Prosecution Declined6. Juvenile/No Custody1.Extradition Declined
1.Arrest2.Exceptional
Jail Number
OBTS Number
Date Cleared
ByAssigned To
AD
MIN
IST
RA
TIV
E
A-AdultJ-Juvenile
Date
Name of Officer Reporting
Officer Reviewing (If Applicable) I.D. Number
I.D. Number/Locator Code
1. Original2. Supplement
Juvenilein Report
JuvenileWarn/Dismiss
1
__/__/____
08/31/2017
08/31/2017 08/31/2017
08/31/2017
08/31/2017
__/__/____
06/09/1979
Signature of Officer Reporting
Signature of Officer Reviewing
Yes No
YYeess NNoo
12 NOFFENSE-INCIDENT REPORTGangRelated
C O P
Y