COUNTY OF LOS ANGELES ACTION: NON-CRIMINAL # OF ADULT ARREST # OF SUBJECT DETENTIONS URN #: Page YES NO 1 CLASSIFICATION I/LEVEL/STAT CODE ATTEMPTED COMPLETED DATE,TIME,DAY OF OCCURRENCE PRINTS REQUESTED BY TIME COMPLETED 3 4 LOC OF OCCURRENCE BUS. NAME SEX OFFENSE VICTIM INFO? YES NO DOMESTIC VIOLENCE NON-PERSONAL PERSONAL INJURY MAJOR MINOR NONE NON-CRIMINAL CODE: V-VICTIM W-WITNESS I-INFORMANT R-REPORTING PARTY P-PARTY CODE # OF LNAME FNAME MNAME SEX RACE ETHNIC ORIGIN DOB AGE 2 3 4 5 RES. ADDR. CITY ZIP VICTIM OF OFFENCE(S) (CLASSIFICATION) # RES. PHONE (Area Code) Day Phone 2 3 4 5 BUS. ADDR.CITYZIPENGLISH SPEAKINGRES. PHONE (Area Code)Day Phone23YES NO5 CODE: S-SUSPECT SJ- SUBJECT M-PATIENT S/V-SUSPECT/VICTIM SJ/V-SUBJECT/VICTIM CODE# OFLNAMEFNAMEMNAMEDRIVERS LICENSE (STATE&NO)2345RES. ADDR.CITYZIPRES. PHONE (Area Code)235BUS. ADDR.CITYZIPRES. PHONE (Area Code)235SEXRACEETHNIC ORIGINHAIREYESHGTWGT.DOBAGE2345CHARGEWHERE DETAINED OR CITE#12AKAMONIKERBOOKING#2VEHICLELICENSE(STATE & No.)YEARMAKEMODELBODY TYPECOLOR#SUSPECTSTATUSIMPOUNDED#VICTIMSTOREDOUTSTANDING235REGISTERED OWNERIDENTIFYING FEATURESCHP 180 SUBMITTEDGARAGE NAME & PH2YES NOBY DEPCOURT EXP/VACATION DATESEMPLOYEE#DEPCOURT EXP/VACATION DATESEMPLOYEE#5STATIONUNIT/CAR #SHIFTAPPROVEDDATETIMEEMPLOYEE#5VICTIME DESIROUS OF PROSECUTIONASSIGNMENTYES NO4HQ NOTIFICATION REQ:DEP.DATE/TIMESPECIAL REQUEST DISTRIBUTIONYES NOSUSP/SUBJ RELEASE APPROVED BYTIMEPCD SUBMITTED:TT B/C BYDATE/TIMESECTY. YES NO