3c.

a
Q-Criii're Roport

LovlbtFffilffi. oE$Rlrtf Nr
1233 FIFTH STREET cLovls, cA 93612 cA 0100100
lclsittiffi
Roport Dale

D General lncldent

tr Telephone Report
D No Prosecution Desired D Miscellaneous lniurv Crirno

Attempl only D MisdemeanorE

Felony
OCCUR

tr

t*o*ot
DAY

oa (oaq)
l
lnME
ITIME

(J

o J ZIcD ii

#r 244bY,

P,.a-.r-ra.2Y I t)onpsrtc,
slate ol catilitmiaE

l-p<-n+
Roporl Time

owoB
BETWN

r>,-,Qrr?- #l-lqR

AND

2r<13
OrcUPATION

Middo) "v ,Onrrzract) l)zsrtrlY //n u.t.677rSBu&4 o

NAIIE (trsl. First.
RESIOENCE ADDRESS

frqA
UNIT

"'btauE
crry

"ba
STATE

-nt 716& DAY lJ torr --. ff..r* r?l'6 I lt<l< tt ) F 'ff-z-e( q36/A Tifr'ilq /
HACE SEX

ZIBCODE

BUSINESS AODRESS

zP cooE

BUS. PHONE

UJ

@ a lrJ z

cooE

NAME (Last, Frst, Middls)

APT CITY

OCCUPATION
STATE

RACE

SEX

DOB

t a
E F
O

RESIOENCE ADDRESS

zrP

cooE cooE

RES. PHOIIE

BUSINESS ADDRESS

UNTT

CITY

STATE

zrP

BUS. PHONE
RACE

cooE

NA IE (Lst, Flrsr, Middlo) APT

UNfT

OCCUPATION

sEx

DOB

RESIOENCE AODRESS BUSINESS ADOBESS

crry
CITY

SIATE
STATE

ZIP CODE

RES. PHONE

ZIP CODE

BUS. PHONE

VEHICLE

Lbens No. - Yoar

- Mak6 - Model - Colors

STRUC TYPE

MOE
Mark ore onty ttoo N/A d 01 Anempt Only E 02 No Fqca Q 03 Kay O 04 Bodily For6

p
0

POE Mail up lo 3
0o r,li

D01

F6t

tr E
O

Cl 02 Floar

D 03 Sld 04 Ground Levsl

u 0

n
a 6

D 05 Saw/Drilf3u,n

fl

[]

06 07 08 09

Hid in tsuilding Channel Lock Pip wronch Tire l.on

O 05 UppGr Llvol O 06 Unknown O 07 Ooot (J og window

O 09 Sllding Glasg 0 1o Oucvskylight o 11 Adiac.nl Building O 12 Root/Skylight

O
Cl

Mark ono only oo N/A or Sngl Fam F6eid 02 Apt./Condo 03 Ouplox/fMhous( oa Hoi6l/Motal 05 OltE( tlosidenos 06 Convgnionc Sto,( 07 Fdr F@d oB R$tauranl

Iot AtHmc
O O O O O

VICTIM ACTION Me* om only

00 N/A
02 At schml.

.. ...
.

Th ic

AddtionB, peson lisled?

TARGETSMa.k ona

onlio'lce lepar,tment on {cladg} rr

..

.SUSPECT

D 'dTto6B uruvrs

3SXl"^*",no"m i4edbf
tl
El C2 Ownor/Employle

(N Bu8ii{ros Clos{t 05 BuingsE.op3n 06 DJivini

O7

lt worr';
Wllkihg

tr

O ro B.ick/R6k O Boll CutlerslPli6r8 Cl r 3 Punch

12

I
IJJ

o
E

O 09 O.w/Medlcal Bldg El l0 Gas Stalim

0bo:olhsr
AREA

oa Ai{ay From

Lx.

Cs SalcrAox NOlIl9 D C4 V6ndlno Mechire PromisoS C c5 Diiplay lldgenC E 04 c6h Domandod 0 Co StoFgs Ari*^ 'rE Custoimrs' ru &5 D6!6dnct Nb usqeve E C7 Q Ca Olhot Corpgo;qi3l 'tr 06 Exit Prsred O Rt Badamsnt;r tt JU )ff c'cbB0ilf&ae wot

H5tEr.3*r9-/

./t

fur
30

O 27 Viclim s Clothing

3;a

"c

H##ffiffi,,""f B vlctim Blindltrbed

llyfvElf'al- BUoildOag ged &b2 \6Oim FgF# ro 0 3
Cowr FatB Victim Forcod lo Oisrobe vktim Forced to Lie O 34
on Flod

O D

13 Wall
I4

z
o a G o F o
f,
ci

fl 15 Tape^vi/e fl 16 scrwdtivot E t7 Sllpwlre E 18 othor

fll4WindowSmash

Garaga

O T.unk/Hd D t7 othet

15 16

Basemd

tr

$itror."" O .O:tA Cliher Non-8oqid.

:El

l1 Retail storg 12 13 Fimngial lnsi, 14 vshtil!, 15 Public-EHo. 16 lnd,u8t{iaj. ,t7

Schrcl :

'l

R2 C, F3

Fmlly Robffioon E ha Garage,roaiFbn ,

Bodrm 1 ogo ,. )ft bu uLu{sli^rr.." Niaa", tr t Ma6turbaled tr 2 Multl Suspect3 lndicaled tr 3 Phono Oisbled tr 4 Pillw Cas6 Taklnruscd tr 5 Pilsr Oisablad tr 6 Sanssckad tr 7 Soloclivo in Lool D D
19

tr oa r-ialiol,r/aeo

El 0t Resilo0lial

O oo N/A

o? conntrrElal

E oitFark
O oc Sisnrct', gl 05.srrb.t g o6:Oihct

FRA PqIFn

F B5 Living Ftodm , E B6 Slo.age Area O Fl7 Kitobon

0ilffiffifin-

-tfSSv6tlilfF6te6f lo M@
O 36 Victim lnjured
O 37 Victim Kidnappod O 38 victim Mole6ted O 39 Vlctim Threalenad
40 Victim Purse Snatched Fi ed Usd O 43 Po886sFs/Selb Drugs .E]44 victim Battsrd {145 Viclim Asssulted 0 4A Olher

l9Olher

O R9 Muntple Rooms ov1 V;h. Pasengor .Comparlmsnl D V2 Veh. Trunk 'E

V3 Voh. Tmlbox

E 4l wbspon B 42 Weapon

.4.

look onty TV/

tr =

D v4 Engitr Comp. El v5 olhor

up to

Sterrc ,/CR
T@k only Nloncy

SECURITY USED -

Mark up to 13

INVESTIGATION J.MBrk

f) 02 BaF/G.ale D 03 Exr. Lighrs !04Camsra E 05 Dog E 06 rnt Lights

O 07 Neighbor watch

FOt None

D OB Opc.alitn lO D 09 Leks

0 ol
E

D E

0ltGuad
12

1O

Forcc

AlsD

D 13 OOF.

F victim conlacted 04 Photo/lmpre8sbn Takon ,q 1 ? Suspoct Cmtactod D 05 Scens Photographor, O 13 Othe, O O Pholo ol Vlctim B 07 Oiagram ol Sccm D Og Neighbore Chrcked
Cl

Dusted tor 02 T@l Mgr*s 03 vohicra/shoo

Lat.nls Nol6d Tr*ks

l1
10 11

O 09 Arla Chdkrd

WllMsos Contaclcd

20 21 O 22 O 23 D 24 E 25

[]

T6k only Jwelry

Under lnfl@nco of Drugt Unscrewed Ughtbulb Vandalizad Vehicl Demandcd/
Stolan

O e6 Vehicla Nsded lo Ramoe Prop

EVIDENCE OBTA]NED

OONme 0!Fingrprints
SOLVABILIW POINTS ts Ws Suspecl arstd

E2weaponrloor D3v6hicle -

-tf

cerntoe osHair

D to ottpr

06staire OTOruge
F

o8BloocilSeren
ClgPr@.ty

Mark a box ttr each solvsble potnl

Ia

lg

Can Susp@t be named can sus9rct be located Can Su$pect be describod

D Witncas lo cri.nc O Srgnilicant M.O. O Properly traceaue

El Sign phys

Att crirno clcmcnt3 prcscnt

B l3lhero slgnltimnl

reason to bsli6va thi6

crim 6n

be solwd?

O Mailr lniury or apo

imvld
Domslic

wilonco

fr
Dato

tsl Can susDoct bo ldedined Ca" aueixa veh be id.nlified

Reporting Of

6/o2
tD#

q-6e e7t
7E/,*,,.
Caso Sl,ats:
FPD.

Molam

?ffif,c ;],Hff
D

D or Q oa KnitaTcur

Firearm tns,

.D @ ottrer weapon

tlQ+ Hands/rwi

lviewed by

.MoR,>
ROUTING:g 6g,gt

t7/3

Closaf-eenOingn

Suspndsd

Unloundod

E
Dat6 Date

'{ nuaLrc ornHorn tr pBoptnry c1!RK tr vlcTrurta,lTNEss sEBVTcES D ppt tr (-ae'-nD vourx srRvcrs -{pnren
1

N DETECTIVES tr PRESS D A.B.C, tr dDsrncl nnoRNEy D JUVENILE HArr D iuv pROBAloN o c.ps. tr

olslributed By
IBM Oata Entry Fited

ES.o.
FpD cBrME ANALv

8y-

oate

18 ----- 7{4
-

-ffiC;ime Report
D General lncident
D Telephone Report I No Prosecution Desired D Miscellaneous lnjury
Code Section

CLOVIS POLICE DEPARTMENT

case

'8i$ff#^'#,il3 sss cA 0100100

t'""'o'"''ot't*Ju
Fleport Dale

Attempt only

tr

Felony n
OCCUR ON/OR BETWN AND
DATE DATE

Misdemeanor{

of- (F,sf

Number

L3A7-:

Paqe One of

trtr

YEJSIL\

l''1"v'au-aaL
First,

aft]TEEJ I

n1

6lt N
$7JJ
Lft

YiLAS

Location of Occurance
CODE

't4D 't^i GETIVStsUfZI- *it7 R Middle) NAME (Last. V zNTat{i:euD. il E:5'TIN v

Report Time

Tir= lilL"
DAY TIME SEX DOB

State ot CaliforniaD

OCCUPATION

RACE

tsDTd,E,A
ZIP CODE

L.J

qt7,u

FESIDENCs ADDRESS

a trl a a u L L
= a
E

44o uJ G,EI|yl'ts;tltZL
NAME (Last. First, Middle)

APT

CITY

STATE

il7,B f-t.l;-VlS
UNIT

C*
STATE STATE

9<& il

RES. PHONF

L74- x-lrf<
SFX DOB

BUSINESS ADDBESS

CITY

ZIP CODE

BUS. PHONE

CODE

OCCUPATION

RACF

PESIDENCE ADDRESS

APT

CITY

ZIP CODE

BES. PHONE

BUSINESS ADDRESS NAME (Last. First, Middle)

UNIT

CITY

STATE

ZIP CODE

BUS, PHONE

CODE

OCCUPATION

RACE

SEX

DO8

o
=

RESIDENCE ADDBESS

APT

CITY

STATE

ZIP CODE ZIP CODE

RES. PHONE

BUSINESS ADDRESS

UNIT

CITY

STATE

BUS. PHONE

VEHICLE

License No.

Year

Make

Model

Colors

Additional person listed?

fl

MOE

POE

STRUC TYPE
Mark one only E] OO N/A D 01 Sngl Fam Resid E[ 02 Apt./condo

VICTIM ACTION
gD0l At Home d oz nt scttoot D 03 Al Work D 04 Business Closed O 05 Business Open E 06 D.iving fl 07 Walking
E]
OO

TARGETS

SUSPECT, \CTIONS
Mark uF lo 24 E]
Cl
OO

t!
D
D

fl [

u
a
6
2
LU

D D D

E
O

Mark one only 00 N/A 01 Attempt Only 02 No Force 03 Key 04 Bodily Force 05 Saw/Drill/Burn 06 Hid in Building 07 Channel Lock 0B Pipe Wrench 09 Tire lron
10 1 1

g f)
O

tl 0

B
D
O

Mark up to 3 oo N/A 01 Front 02 Rear 03 Side 04 Ground Level 05 Upper Level 06 Unknown 07 Door

Mark one only N/A

tr 00 N/A

Mark one onlv N/A

OC1 Cash Reg/Drawer D C2 Owner/Emplopg;.

O C3 Sate/Box D C4 Vending MactPBli E C5 Display ltems 0 C6 Storage nrea ig1 6 D C7 Customer O c8 Olher Comm*&Fft D R1 B6ement fl R2 Bedroom Aget O R3 Family R@m/Den O Ra carage/carpafid O R5 Living Room O Ro Storage AreJilSL n R7 Krtchen

D 27 Victim's Clothing
CuVRipped i'e

E 03 Duplex/fownhous
D D D O
04 05 06 07 n 08 E 09 HotevMotel
Other Residence

69PXrcot*fr &, BFFdpa

0'l Alarm Disabled

c pFe qdno

d$dj'fr[#ffibn

{dare)

convenience Stor Fast Food

Restaurant

E'mm#"m""i:i'.".
^9
Oe

63t"$eru;:v::' -Tl5i-Wfiffits6lntr/Gmoeo
32 victim Forced to

"

@t0q/rFed

n 08 window D 09 Sliding Glass 0

10 DucVSkylight 12 Root/Skylight 14 carage 15 Basement 16 Trunk/Hood

t
e)
@

D E E D

Brick/Rock Unknown Pry Bar

011 AdjacenlBuilding
D
O 13 Wall

E !l
D D D

fl

12 Bolt Cuders/Pliers 13 Punch 14 Window Smash

D '15 Tape,ryVire D 16 Screwdriver D 17 Slip wr.e

O 1 7 Other

fl

1B

orher

D n f] fl E

Drug/Medical Bldg 10 Gas Station 11 BetailSlore 12 School 13 Financial lnst. 14 Vehicle 15 Public Bldg. 1 6 lndustrial 1 7 Street 18 Other Non-Flesid. 1 9 Other

D 08 Away From D Og Olher

Loc.

/6 oEi$Mma,-r: G*aftf,}alp,",o,
Lookout

""

Used

D 34 Vrctrm Forced tdlle on Ftoor J

AREA
g?01 Res;denlral b 02 Commerqal

OO

N/A

-0 35, Vrctim Forced lo Move idQFv,crlQ rnlurlUl! E??M:ifinY"TsB'''eBu i6 l2gngtlpqeqpp,tr1 noicareo O 37 Victim Kidnapped

03 D 04 D 05 D 06

Park

F F8

Person ,':Cl9

13 PhofrfDE5dlb'd

School
Street

O Flg Multiple Rooms

O V1 Veh. Passenger

1.?#.*#St',:"' D 6 Ransacked
1

Olher

Companment

D 1 7 Selective in

n n

tr = tr
ts

V2 Veh. Trunk V3 Veh. Toolbox D V4 Engine Comp O v5 orher

SFCIIRITY IISFD - M',r,,n'^ 13 n 08 Operatron E Ot t.tone

INVESTIGATION lD

o
e)

fl 02 Bars/Grale tr 03 Ex1. Lighis fi 04 Camera D 05 Dog D 06,nt Lighrs

-]

09
10

Locks

El

Fence

11
12

Guard Alarm

13

othe-

n fl

D D D D D

01 02 03 04 05 Scene Pholographed 06 Pholo ol Victim 08 Neighbors Checked

Mark up to 11 Dusted tor Lalents D 09 Area Checked Tool Marks Noted D 10 Witnesses Conlacted Vehicle/Shoe Tracks F 1 1 Victim Contacled Pholo/lmpressron Taken S 1 2 Susoecl Conlacled

tl t: Otn"t

Loot 18 Smoked on Premises 19 Took only TV,, Stereo/VCR n 20 Took only Money 21 Took only Jewelry D A 22 'Jndq lnlluence of Druos Q 23 Unscrewed Lightbulb D 24 Vandalized F 25 Vehicle Demanded/ Stolen fl 26 Vehicle Needed 10 Bemove Prop

D 38 victim Molested 0 39 Victim Threalened -Laqllicli@-ButFg*qnatche d O 41 weapon Fired O 42 Weapon Used U 43 Possesses/Sells Drugs 6'44 Victim Banered
O 45 Victim Assautted

D 48 Other

07 Neighbor watch

EVIDENCE OBTAINED

! fl
2

10 Other

IL

YI
D
1

None

weapon/Tool

q
=

Fingerprints

O 3 Vehicle

0 g

4 Photos 5 Hair

u b >Ialns

7 Drugs

D 8 Blood/Semen D 9 Property

SOLVABILITY POINTS E Was S!specl arrested

Mark a box for each solvable point

F Can Suspect be named 0$ Can Suspect be localed SCan Suspect be described

Feporting Otficer

D Witness to crime D Significant M.O. D Property traceable 0 Siqn phys evidence

BAll

Crime etements present D Major injury or rape involved D Can suspect be identitied D Can susDect Veh be identified

D ls there significanl reason to believe this crime can be solved?

tD#

Date

Unit # vio6nce

Domestic

^*""ru(^/
FOUTING:g

R {\fteorttro\ ,'
66r*t

<L*it
rD#

Klt,lt''< r-rl
Date Case Status:

v;;;";;; wuupo" I

01 Firearm 02 Kniie/Cut lnst

03 orher weapon

FO4 Hands/Feet

{,t3( ?L?'{ri
I
#
DETECTIVES N JUVENILE HALL
PROPERTY CLERK

CtoseOS

Pending
F,PD,

Suspended

Unfounded

ffil*au ATTORNEY K ptteLrc DEFENDER !

tr
YOUTH SERVICES

tr tr
tr

PRESS

tr

A,B.C.

JUV PROBATION
VICTIM,ryVITNESS SEBVICES

OtHe

7F7t

zt/!t<-

D C-PS. tr N PPI N

ES.O. FPD CRIMEANALY

Disr'buiedBv WlAe\^ terua oata rntrv -Filed

Date YIanlCt

ou,.-WIOT
Date

ti

118 -.---. e9

7-04

p Crime BePort [] General lncident

LJTelephone RePort D No Prosecution Desired

cLovrs PiiFcr??TffiMFFrn 3
CLOVIS, CA 93612 cA 0100'100

I
MisdemeanorD

Felony

lr4iscellaneous lniury

o
J

Localion o{ Occurance

-.)qo

\,rJ GgiTjlg-RG
NAME (Last, First, Middle)

*rra

ts

fa Af<- \+ F o R D--De-Sr]lj

tlt
uJ

BACE NAME (Lasl. First. Middle)

a Lll
2

ASrYr6f?
ZIP CODE

RESIDENCE ADDRESS

49at>
NAME (Last, First' Middle)

a
I

F (J

5
VEHAG- Li""^* N6-_
MOE
Mark one onlY

Y".-

Make

Model

Colors

POE
only

STRUC TYPE

VICTIM ACTION
Mark one only E OO N/A p ol At Home E 02 At School O 03 At work D 04 Business Closed E 05 Business OPen O 06 Drivinq E! 07 walking D 08 Away Ftom Loc. O 09 olher

TARGETS
Mark one onlv o oo NiA D C1 casb Reg/Drawer D C2 Owner/EmPloyee 0 C3 Safe/Box f) C4 vending Machine 0 C5 DisPlaY ltems O C6 Stotaqe Area E C7 Cuslomet O CO Other Commercial D Rl Basement n R2 Bedroof, D R3 Family Roorrr'fuil 0 R4 Garage/CarPoft D R5 Lving Boom loin RB Sloraoe Area

Eloo N/A

A
E

Mark uP to 3 oo N/A
01

n
D

01 AnemDt

02 No Force

Front

Mark one only 00 N/A 01 Sogl Fam Fesid

SUSPECT ACTIONS Mark up lo 24

V tr
L a 5
{UJ

O os xey D 04 Bodily Force

02 Reat 03 Side

'll

El 02 Apt./Condo

05 D 06 fl 07 f] oa Cl 09

Saw/Drill/Burn Hid in Building Channel Lock PiPe wrench Tire lron

D 04 Ground Level O 05 Upper Level

06 Unknown
07
oE

D
O

Door

10
1

BricldBock Unknown Pry Ba.

f]

12 Bolt Cuners/Pliers C] 1 3 Punch E 14 Window Smash

D Ducvskylight D Adiacent Building O 12 Root/Skylight D 13 Wall

Cl
1

og 1 0 11

window sliding Glass

o3 Duotexrrow 04 Hotel/Motel D 05 othet Residence O 06 Convenience D 07 Fast Food O 08 Restautant El 09 Drug/Medical O 1o Gas Slation O 11 Retail Store O 12 Sch@l D 13 Financial lnst

oo 01 Alarm Disableo E) 02 Alcohol on Breath D 03 Ate/Drank on

N/A

Premises

04 Csh Demanded D 05 Demand Note Used O 05 Exit Prepared

I I I I I I I

27 Victim's clothing CuVRiPPed D 2e Vi"ti- Name Used " D 29 viclim's Tools used E 30 viclim Blind{olded 0 31 victim Bound/Gagged El 32 Vicrim Fo.ced to Cover Face

AREA

f]

oo NIA

4 6

El

15 Tape,^r'vire 16 Screwdriver 17 sliP wire 18 olher

15
1

D D

Garage gasement Trunk/Hood

O 14 vehicle D 15 Public Bldg. E 16 lndustrial

El O1

Fesidential o2 Commercial

D 03 Park

79 RB Petson

6 nz r,r"nJn Na
n vl
Veh. Passenoer

17

other

n E

17 Street 18 Other Non-Resid

fl tl

15 p9ry91 !i5qbted
,

D 1 I other

04 school 05 street D 06 other

co-oan-e.ttQfl
O V2 Veh.
Cl V3 Veh. T@lbox

O
I

[nA'.6erecq8*in LqgF

Trunk ..^ Ll I

18 Smoked on Premises

$edrye{9n u+}v

E
t'i

O V4 Engine Comh D v5 olher

fJ a3 Possesses/Selld DIugs B 44 victim Battered O 45 viclim Assaulted

IL (f, !e

SECURITY USED - MarkuPto i3

E) 01 None 'El 02 Bars,'Gtale 0 03 Ext. Lighls

D D

08 Operalion lD 10 Fence

D 09 Locks

o
*
tL

O04Camera O 05 Dog D06lnt.Lights

nllGuard
D l2Alarm

INVESTIGATION - Mark uP to 11 D 09 Area Checked n 01 Dusted lor Latenls F 1o wilnesses conlacted E 6i i*r-v"tr" ruor.o i oi v.ni"tu/St'oe ttact E 1 1 victim conlacted " Conlacted E oo prrotolr-pt""sion Taken E 12 Suspecl PhotogtaPhed D 13 Olhel El 05 Scene
D oo Photo ol victim O 07 Diagram ol Scene O 0B Neighbors Checked

D 22 Under lnfluence ol O 23 Unscrewed Lightbulb D 24 vandalized

25 vehicle Demandedl Stolen O 26 vehicle Needed lo Remove Prop

E l3Other

D 07 Neighbor Walch

EVIDENCE OBTAINED

U
D 2 weaponffool 0 3 vehicle E 4 Photos

10

other

B o None O 1 FingerPrints
SOLVABILITY POINTS

f]

f]

5 Hair

6 slains O 7 Drugs

D 8 Blood/Semen D 9 Propeny

Mark a box lor each solvable poinl 0 Witness to crime fl Significanl M.O. Can Suspecl be named O Property traceable Can Suspect be located D Sign phys evidence can Susgecl be described

D
El Alt Crime elemenls Present 0 Major injury or IaPe involved E Can susPect be rdentified fl Can susPect Veh be Idenlilied

ls there signiticanl reason to believe this c.ime can be solved?

"$"J;j: Eil il;ill",,^.,

Closed

E3: $"x'J#""T-

RenOingft? Suspended

Unfounded

fl
uate

ROUTING:3

r'r*'t
DISTRICT ATTORNEY PUBLIC DEFENDER YOUTH SERVICES

N DEIECTIVES D D N
JUVENILE

PRESS JUV. PROBATION VIC SS SERVICES

D D

HALI tr PBOPERTY CLERK D

! n c Ag.3
D

A.B.C

tr
D D

Distributed
FPD,

Bv

rBM Dala
TS.O

c.Ps

Entry
-l--o--

CXi)'-0"r"
Dale

PPI

FPDCRIMEANALY

FiIEdBY

tr

QOTHER

7-04

aTfutoltrTq{h+"
AP
P

tb

tas( #lAtWLbVBEq

'

LtCATlOrn'FOR EM

(Name):0O

1.

P(n i-lrZ-.

r.

frJr */A{
d

PERSON(S) TO BE PROTECTED (insert names

RG ENCY P ROTECTIVE ORD Ef,' (CLETS has provided the inlormation in items 1-5. all persons to be protected by this order):
E

TRAINED (nane):

se*,

F fi.: fu-) .wll1 A+ir

cotor:SRl.l rye cotor.W.nace:

VL/

ege:}

.5

Dare of birrh:

3.

The events that cause the protected person to fear immediate and present danger of domestic violence, child abuse, child abduction, stalking, workplace violence, or civil harassment are (give facts and dates; specify weapons):

a. b.

l--l

T-]

l--l l--l
8.

l---1 will NOT be filed. willbe ln accordance with Penal Code section 646.91. these orders are requested, flqne calllo (name of judicialofficer): The iudicial officer oranted the Emeroencv ProtectMe Order that follows.

l--|

to be prote6ted lives with the person to be restrained and requests an order that the restrained person move out immediately from the address in item 9. The person to be protected has minor children in common with the person to be restrained, and a temporary custody l---l does order is requested because of the facts alleged in item 3. A custody order exist. The person to be protected is a minor child in immediate danger of being abducted by the person to be restrained because of the facts alleged in item 3. n child welfare worker or probation otficer has advised the undersigned that a juvenile court petition

l--l Oo".

not

filed.

l--l

civil harassmenl

lace violence

By: P
\gency:

*Affi QIN,
(PRINT NAME OF LAW

)
(SIGNATURE OF LAW ENFORCEMENT OFFICER)

Telephone No.:

Badge No.:

2'S

EMERGENCY PROTECTIVE ORDER

9.
To restrained person (name):

a.[.-l-Youmust'ft9teontact,molesihaiass,aitachstrike,thrca1ense

[ ,l

1o.n
1

follow, stalk, destroy any personal property, or disturb the peace of each person named in item 1. yards from each person named in item 1. You stay away at yards l*_]l roue stav away at imrnediatbly.from "ut (address): is given temporary care and control of the following fiame): minor children of the parties (names and ages)

must f-] l.l

least least

from

1. Reasonable grounds for the issuance of this order exist and an emergency protective order is necessary to prevent the occuffence or recurrence of domestic violence, child abuse, child abduction, stalking, worlglace violence, or civil harassment.

12. THIS EMERGENCY PROTECTIVE ORDER WILL EXPIRE AT 5:00 P.M. ON: To protected person: lf you need protection for a longer period of time, you must request permanent protective orders at (court nan and address):

INSERT DATE OF FIFTH FULL COURT DAYI DO NOT COUNT DAY THE ORDER IS GRANTED

13. Person served (name): 14. I personally delivered copies to the person served as Date: Time: Address: 15. At the time of service I was at leasl '18 years of age and not a party to this cause. 16. My name, address, and telephone number are (this does not have to be seruels home telephone number or address):

PROOF OF SERVICE

follows:

California sheritf or marshal

I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correcl.

)
(SIGNATUBE OF SERVER)

Fom Adopted by Flule 1295.90

Judicial Council of Calif ornia '1295.90 fRev. January'1,1 9991 ONE copy

io

cart

EMERGENCY PROTECTIVE ORDER (CLETS) (Domestic Violence, Child Abuse', Workplace Violence, Civil Harassment)
ONE coFy

FmiV

Code, $ 6240 et sq. Penal Code, S 646.9

lo Estraimd persm,

ONE copy io

FotecEd persfi,

FSC 1295.90 R01-99

ONE c(*ry to issuing agency

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D General lncldent

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D No Prosecution Desired D Miscellaneous lniurv Crirno

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VEHICLE

Lbens No. - Yoar

- Mak6 - Model - Colors

STRUC TYPE

MOE
Mark ore onty ttoo N/A d 01 Anempt Only E 02 No Fqca Q 03 Kay O 04 Bodily For6

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0

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a 6

D 05 Saw/Drilf3u,n

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06 07 08 09

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O 05 UppGr Llvol O 06 Unknown O 07 Ooot (J og window

O 09 Sllding Glasg 0 1o Oucvskylight o 11 Adiac.nl Building O 12 Root/Skylight

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Cl

Mark ono only oo N/A or Sngl Fam F6eid 02 Apt./Condo 03 Ouplox/fMhous( oa Hoi6l/Motal 05 OltE( tlosidenos 06 Convgnionc Sto,( 07 Fdr F@d oB R$tauranl

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O O O O O

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AREA

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Cs SalcrAox NOlIl9 D C4 V6ndlno Mechire PromisoS C c5 Diiplay lldgenC E 04 c6h Domandod 0 Co StoFgs Ari*^ 'rE Custoimrs' ru &5 D6!6dnct Nb usqeve E C7 Q Ca Olhot Corpgo;qi3l 'tr 06 Exit Prsred O Rt Badamsnt;r tt JU )ff c'cbB0ilf&ae wot

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30

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on Flod

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13 Wall
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15 16

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19

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O 36 Victim lnjured
O 37 Victim Kidnappod O 38 victim Mole6ted O 39 Vlctim Threalenad
40 Victim Purse Snatched Fi ed Usd O 43 Po886sFs/Selb Drugs .E]44 victim Battsrd {145 Viclim Asssulted 0 4A Olher

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O R9 Muntple Rooms ov1 V;h. Pasengor .Comparlmsnl D V2 Veh. Trunk 'E

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D v4 Engitr Comp. El v5 olhor

up to

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T@k only Nloncy

SECURITY USED -

Mark up to 13

INVESTIGATION J.MBrk

f) 02 BaF/G.ale D 03 Exr. Lighrs !04Camsra E 05 Dog E 06 rnt Lights

O 07 Neighbor watch

FOt None

D OB Opc.alitn lO D 09 Leks

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12

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D 13 OOF.

F victim conlacted 04 Photo/lmpre8sbn Takon ,q 1 ? Suspoct Cmtactod D 05 Scens Photographor, O 13 Othe, O O Pholo ol Vlctim B 07 Oiagram ol Sccm D Og Neighbore Chrcked
Cl

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Lat.nls Nol6d Tr*ks

l1
10 11

O 09 Arla Chdkrd

WllMsos Contaclcd

20 21 O 22 O 23 D 24 E 25

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T6k only Jwelry

Under lnfl@nco of Drugt Unscrewed Ughtbulb Vandalizad Vehicl Demandcd/
Stolan

O e6 Vehicla Nsded lo Ramoe Prop

EVIDENCE OBTA]NED

OONme 0!Fingrprints
SOLVABILIW POINTS ts Ws Suspecl arstd

E2weaponrloor D3v6hicle -

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F

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Can Susp@t be named can sus9rct be located Can Su$pect be describod

D Witncas lo cri.nc O Srgnilicant M.O. O Properly traceaue

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reason to bsli6va thi6

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Reporting Of

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Dat6 Date

'{ nuaLrc ornHorn tr pBoptnry c1!RK tr vlcTrurta,lTNEss sEBVTcES D ppt tr (-ae'-nD vourx srRvcrs -{pnren
1

N DETECTIVES tr PRESS D A.B.C, tr dDsrncl nnoRNEy D JUVENILE HArr D iuv pROBAloN o c.ps. tr

olslributed By
IBM Oata Entry Fited

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18 ----- 7{4
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