INCIDENT REPORT ATLANTA POLICE DEPARTMENT Page of

PROPERTY DATA VEHICLE DATA REPORTING VICTIM / WITNESS DATA INCIDENT DATA

PERSON

Incident / CICA No.

2. Date of Report:

Mo. Day Year Time

3. Ga. Code(s)	4. Conf.	5. Vic. #	6. UCR Class	7. Reserved
8. Beat:

9. Location of Incident: (Street #, street name, Apt #) NW NE

SW SE

Fulton

Dekalb

Airport	10. Location Type:*

Date/Time Incident:

Mo. Day Year Time Mo. Day Year Time

12. Reporting Officer: (L/F/M, Suffix)

13. Sex

14. APD ID NO.

15. Assignment

16. Count Code: Reported Case Witnessed Case	Off Days:	S M T W T F S

Regular Court Time:
17. Specify what crime was committed:

18. Attempt Only

Yes No	19. Weapon or Tool:*

20.Temperature / Weather: 1 Clear 4 Snow

Hot Cold 2 Cloudy 5 Sleet

Warm Cool 3 Rain 6 Fog	21. Forced Entry? Yes No

22. Alcohol Related? Yes No

23. Bias Incident? yes No	24. Gang Related? Yes No

25. Family Violence? Yes No

26. Security Devices? Yes No	27. Special Events? Yes No (list)

28. Incident appear Yes

drug related? No	29. If Yes, Indicate 01 Amphetamine 02 Barbiturate 03 Cocaine 04 Hallucinogen 05 Heroin

type of drug(s): 06 Marijuana 07 Methamphetamine 08 Opium 09 Synthetic Narcotic U Unknown
1. Code:*

2. Name: (L/F/M, Suffix) ADLT JUV BUS GOV POL

3. Race:*

4. Sex

5. Date of Birth:

6. Ga. Code(s)	7. UCR Class
8. Address: (Street #, street name, Apt. #, City, St., Zip )

9. Work Phone

( ) -	10. Sobriety

1 Sober 4 UI / Alcohol UI / Both

2 Unk 5 UI / Synthetic Narcotic Alcohol / Drugs
11. Temporary Address

Until:

12. Home Phone

( ) -	Prosecute / Testify:

Yes No	Victim Notified of

Rights: Yes No
Relation to Offender:*

Med. Treat. - Hospital / Treat. Center:

Yes No	Extent of Injury

None Minor

Serious Fatal	18. Location of Injury on body:

19. Type of Injury:*

20. If no injury, describe threat / act:

21. Victim’s School: (Name, Address)

1. Code:*

2. Name: (L/F/M, Suffix) ADLT JUV BUS GOV POL

3. Race:*

4. Sex

5. Date of Birth:

6. Ga. Code(s)	7. UCR Class
8. Address: (Street #, street name, Apt. #, City, St., Zip )

9. Work Phone

( ) -

10. Sobriety

1 Sober 4 UI / Alcohol UI / Both

2 Unk 5 UI / Synthetic Narcotic Alcohol / Drugs
11. Temporary Address

Until:

12. Home Phone

( ) -

Prosecute / Testify:

Yes No	14. Victim Notified of Rights:

Yes No
15. Relation to Offender:*

16. Med. Treat – Hospital / Treat. Center:

Yes No

17. Extend of Injury

None Minor

Serious Fatal

18. Location of Injury on body:

19. Type of Injury:*

20. If no injury, describe threat / act:

21. Victim’s School: (Name, Address)

2. Reporting person’s Name: (L/F/M, Suffix)

3. Race:*

4. Sex

5. Date of Birth:

6. Testify:

Yes

No	7. Relation to Victim/ Offender:*

8. Sobriety: 1 Sober 2 Unknown 4 UI / Alcohol 5 UI / Drugs 6 UI / Combination of Alcohol / Drugs
9. Address: (Street #, street name, Apt. #, St., Zip)

10. Work Phone

( ) -	11. Home Phone

( ) -
1. Also see #

Impound Report(s) :

2. Owner’s Name: (L/F/M, Suffix)

Address: (Street #, street name, Apt. #, City, St., Zip )

3. Work Phone

( ) -
4. Driver’s Name: (L/F/M, Suffix)

5. Is Driver Owner?

Yes No	6. Record Type: S Stolen Other

T Theft from Vehicle R Recovered

V Suspect Vehicle D Damaged	7. Home Phone

( ) -
8. Vehicle Type:*

9. Year

10. Make:

11. Model

12. VIN

13. Vehicle Style:*

14. Color

15. Tag Number:

16. State

17. Year

18. Tag Type*

19. Doors Locked? Yes No

Ignition Locked? Yes No

Keys in Ignition? Yes No
Date Lost / Stolen

Stolen

Veh. Value $	Recovered

Veh. Value $	Vehicle Reported Stolen

In Atlanta Outside	If out, jurisdiction:

1. Also see # Prop. /Evidence

Inventory(s)

2. Cont’ on back

of suppl. narr.

Yes No	RECORD TYPE:

D – Damaged L – Lost

R – Recovered S – Stolen	PROPERTY TYPE: B – Currency C – Jewelry

F – Office Equipment E – Clothing G – Electronics

H – Household Goods I – Firearms J – Consumables

L – Others	PROPERTY STATUS:

F – Found R – Returned

N/A - Not in Possession of APD

3. Record

Type*	4. # QUNTITY / DESCRIPTION

Make – Model – Identifying Feature	5. Property

Type*	6. Serial No. or Identifying No.	7. Estimated Value –

$ Amount	8. Property

Status*
#
#
#
#
Form APD 001 Revised 1/22/08

DRUGS ARRESTED PERSON / SUSPECT / MISSING PERSON DATA	Incident / CICA No.

ATLANTA POLICE DEPARTMENT INCIDENT REPORT (back )
1. APR Copy SUS MIS PRI. AGG.	2. UCR Code	1. APR Copy SUS MIS PRI. AGG.	2. UCR Code
3. Name (L/F/M, Suffix)

4. GCIC / Status	3. Name (L/F/M, Suffix)

4. GCIC / Status
5. D.O.B.

6. Sex

7. Race*

8. Alias

Assoc.	5. D.O.B.

6. Sex

7. Race*

8. Alias

Assoc.
9. Age

To	10. Height

To	11. Weight

To	12. Build*

9. Age

To	10. Height

To	11. Weight

To	12. Build*

13. Residence

Telephone

( ) -	13. Residence

Telephone

( ) -
14. Who ID’d this person?

15. Occupation / Gang

14. Who ID’d this person?

15. Occupation / Gang

16. DL

SSN	State

17. School

16. DL

SSN	State

17. School

18. Hat

19. Shirt

20. Pants Shorts

Dress Skirt	18. Hat

19. Shirt

20. Pants Shorts

Dress Skirt
21. Coat

22. Shoes

23. Clothing Type*

21. Coat

22. Shoes

23. Clothing Type*

24. Hair color*

25. Style*

26. Eye color*

27. Eye Defect*

24. Hair color*

25. Style*

26. Eye color*

27. Eye Defect*

28. Facial Hair*

29. Teeth*

30. Skin Tone*

31. Complexion*

28. Facial Hair*

29. Teeth*

30. Skin Tone*

31. Complexion*

32. Hand Use*

33. Jewelry

34. Oddity*

35. Speech*

32. Hand Use*

33. Jewelry

34. Oddity*

35. Speech*

36. Impersonate*

37. Amp/Deform

38. Scar Mark Tattoo

(location / description)*	36. Impersonate*

37. Amp/Deform

38. Scar Mark Tattoo

(location / description)*
39. Med. Treat. Rec’d – Hospital / Treatment Center:

Yes No	39. Med. Treat. Rec’d – Hospital / Treatment Center:

Yes No
40. Injury Extent*

41. Injury Location (body)

42. Injury Type*

40. Injury Extent*

41. Injury Location (body)

42. Injury Type*

43. Arrest Date Time

44. Arrest Location(Street #,street name, Apt #)NW NE

43. Arrest Date Time

44. Arrest Location(Street #,street name, Apt #)NW NE

45. Weapon Auto

46. Weapon Auto

45. Weapon Auto

46. Weapon Auto

47. # Chgs.

48. Court Date Time

49. Sobriety

1 Sober 4 UI / Alcohol 6 UI / Both

2 Unk 5 UI / Drugs Alcohol/Drugs	47. # Chgs.

48. Court Date Time

49. Sobriety

1 Sober 4 UI / Alcohol 6 UI / Both

2 Unk 5 UI / Drugs Alcohol/Drugs
50. Charges (Code #/ Title)

50. Charges (Code #/ Title)

51. M.P.Type:*

52. M.P.Status*

53. Foul Play?

Yes No

Unk	54. Prev. Missing?

Yes No	55. Rec. Code:*

51. M.P.Type:*

52. M.P.Status*

53. Foul Play?

Yes No

Unk	54. Prev. Missing?

Yes No	55. Rec. Code

56. Drug Activity:

None Buy Sell

Possess History of Use	57. Drug Type:*

58. Qty. Drug:

56. Drug Activity:

None Buy Sell

Possess History of Use	57. Drug Type:*

58. Qty. Drug:

59. Was ID work requested or completed? Yes No

Work Performed: Photo Fingerprint Composite Other	60. Performed By:

61. Point of Entry*

62. Method of Entry*

63. Security Measures*

64. Perpetrator Actions toward Victim: (Code Series A-J)*

65. Perpetrator Behavior/ / Actions: (Code Series K-S)*

66.
THE UNDERSIGNED, BEING DULY SWORN, UPON HIS OR HER OATH, DEPOSES AND STATES THAT THE FOREGOING IS TRUE, CORRECT, COMPLETE AND LEGIBLE TO THE BEST OF HIS/HER KNOWLEDGE AND RELIEF.
67. Referred to: RD HR Vice Hom Burg Youth

Zone FV Fug SD Sex Larc PS2

AHA CP Narc SIS Rob AT	68. Reporting Officer’s Signature	69. APD ID No.

70. SWORN TO AND SUBSCRIBED BEFORE ME

THIS ________ DAY OF _________________________________, 20 _______.
72. APD ID No.	73. Supervisor’s Signature	74. APD ID No.

Form APD 001 Revised 1/22/08

INCIDENT REPORT

AJordan

2008-01-22

VLivsey