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0000
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DO o
01.0. Card
Date Of Birth
Refused
Summons No.
Arrest No.
o
o Shield
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ApI. No.
Photo 1.0.
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o
Nicknamel
Street Name
If No, How Identified?
o Verbal
L
No
Period Of Observation
Prior To Stop
Yes 0
Time Of Stop
o
What Were Circumstances Which Led To Stop?
(MUST CHECK AT LEAST ONE BOX)
o Carrying Objects In Plain V_ 0 Actions Indicative Of Engaging
Used In Commission Of Crime In Drug Tran&aClion.
o.g.. Slim JirN'Pry Bar. etc. 0 Ftwtive Movements.
o Fits Description. 0 Actions Indicative Of Engaging
o Actions 1ncSic:atNe Of Casing" In VIOlent Crimes.
VlClim Or Location. 0 Wearing CIotheslOisguises
o Actions Indicative of Ading As A Commonly Used In
Lookovl. Commission Of Crime.
D Suspicious BuIQelObjoct (Describe)
o Other Reasonable Suspicion Of CrimirJal Activity (Specify)
Specify Which FelonylP.L. Misdemeanor Suspected Duration Of Slop
o Inside Type Of Location
o Outside 0 Housin Describe:
Name Of Person Stopped
Address/Intersection Or Cross Streets Of Slop
OffICer In Uniform?
Address
COMPLETE ALL CAPTIONS
I
z
>
I
" "
i
I
i
0000
l
DO o
01.0. Card
Date Of Birth
Refused
Summons No.
Arrest No.
o
o Shield
l
ApI. No.
Photo 1.0.
l
o
Nicknamel
Street Name
If No, How Identified?
o Verbal
L
No
Period Of Observation
Prior To Stop
Yes 0
Time Of Stop
o
What Were Circumstances Which Led To Stop?
(MUST CHECK AT LEAST ONE BOX)
o Carrying Objects In Plain V_ 0 Actions Indicative Of Engaging
Used In Commission Of Crime In Drug Tran&aClion.
o.g.. Slim JirN'Pry Bar. etc. 0 Ftwtive Movements.
o Fits Description. 0 Actions Indicative Of Engaging
o Actions 1ncSic:atNe Of Casing" In VIOlent Crimes.
VlClim Or Location. 0 Wearing CIotheslOisguises
o Actions Indicative of Ading As A Commonly Used In
Lookovl. Commission Of Crime.
D Suspicious BuIQelObjoct (Describe)
o Other Reasonable Suspicion Of CrimirJal Activity (Specify)
Specify Which FelonylP.L. Misdemeanor Suspected Duration Of Slop
o Inside Type Of Location
o Outside 0 Housin Describe:
Name Of Person Stopped
Address/Intersection Or Cross Streets Of Slop
OffICer In Uniform?
Address
COMPLETE ALL CAPTIONS