| Location of Arrest (including Name of Business) |
| Location of Offenses (Business Name, Address) |
| Date of Arrest Time of Arrest Booking Date Booking Time Jail Date Jail Time Location of Vehicle |
| Name (Last, First, Middle) Alias (Name, DOB, Soc. Sec, #, Ec.) |
| Race Black American Indian Oral/Aural |
| Scarce, Masks, Tattoos, Unique Physical Features (Location, Type, Description) |
| Marital Status Religion Indication of Alcohol Abuse Y N U Lk |
| Local Address (Street, Apt. Number) (City) (State) (Zip) Phone 1. City 2. County 3. State 4. Out of State |
| Permanent Address (Street, Apt. Number) (City) (State) (Zip) Phone 1. Address Source |
| Business Address (Name, Street) (City) (Zip) Phone 1. Occupation |
| DL Number, State Soc. Sec. Number RD Number Place of Birth (City, State) Citizen/Nep |
| Go-Defendant Name (Last, First, Middle) Race Sex Date of Birth 1. Amled Age 2. Ethnicity 3. Mortality Monitor 4. Juvenile 5. Permanent Address (Street, Apt. Number) (City) (State) (Zip) Phone 1. Address Source |
| Parent Name (Last) (First) (Middle) Residence Phone 1. Parent Logo Custodian City Address (Street, Apt. Number) (City) (State) (Zip) Business Phone 1. |
| JUVENTIL TJAC Date Time |
| The above address was provided by [ ] defender(s) and [ ] defender(s' parent). The child and/or parent was with [ ] defender(s). Office Phone: 952-2638 information on the change of address. No. (Reason) Value of Property |
| Property View No Description of Property |
| Change Description Courts Domestic Volunteer Number Volunteer ID of ORD # |
Char
| DISTRIBUTION: | WHITE — COURT COPY | GREEN — STATE ATTORNEY | YELLOW — AGENCY | PINK — JAIL | GOLD · DEFENDANT (N.T.A's ONLY) |
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