pg of

NARRATIVE

CONTINUED ON SUPPLEMENTAL REPORT

MFG MODEL GA./CAL. SERIAL NO. OWNER

MFG MODEL GA./CAL. SERIAL NO. OWNER

F REARMS

MFG MODEL GA./CAL. SERIAL NO. OWNER

MFG MODEL GA./CAL. SERIAL NO. OWNER

MAKE MODEL COLOR

VEHICLE
LIC. NO. STATE VN

OWNER ADDRESS

MFG MODEL COLOR

BOAT
EVIDENCE

REG. NO. HULL I D.

OWNER ADDRESS

OUTBOARD MAKE MODEL H.P. SERIAL NO.

MOTOR
OWNER ADDRESS

OTHER
EVIDENCE

DISPOSITION OF
EVIDENCE

REPORT NG OFFICERS OFFICER I.D. NUMBER DATE

__ ACTIVE
ADMINISTRATIVE

__ ADMIN OFFICER I.D. NUMBER DATE

CLOSED

DISPOSITION OF REPORT:
__ UNFOUNDED

__ PENDING APPROVED BY DATE

TRIAL

18-11643
 pg of
AGENCY I.D. SUPPLEMENTAL REPORT CASE NUMBER NCIC
SC0 400500 INQ. ENTD.
STATUS

ORIGINAL REPORT ADDITIONAL SUBJECTS ADDITIONAL CHARGES ADDITIONAL WITNESSES ADDITIONAL SEIZED PROPERTY

SUPPLEMENTAL REPORT MOD FIES ORIG NAL CASE STATUS CHANGE DISPOSITION/TRIAL REPORT ADDITIONAL VICTIMS
NARRATIVE
DISP.

GU LTY NOLO CONTENDRE NOT GU LTY DISMISSED DECLINED PROSECUTION

REPORT NG OFFICERS OFFICER ID NUMBER DATE

__ ACTIVE
ADMINISTRATIVE

__ ADMIN OFFICER ID NUMBER DATE

CLOSED

DISPOSITION OF REPORT:
__ UNFOUNDED

__ PENDING APPROVED BY DATE

TRIAL

18-11643
 pg of

AFFIDAVIT

I, ,being first duly sworn(or affirmed)do repose and say as follows: I have been advised
of and understand my right under the Constitution of the United States to refuse to be a witness against myself, that
any statement I make may be used against me. Knowing this, I make the following statement freely and voluntarily to
who has identified himself to me as an official of the South Carolina Department of Natural
Resources, Law Enforcement Division.

I have read this statement consisting of page(s)and have initialed all corrections. I fully understand its entire
contents and solemnly swear (or affirm) that it is true and correct to the best of my knowledge and belief. No threats or
promises have been made to obtain this statement.

Described and sworn to (or affirmed) before me, this day of , 20

AFFIANT

ADDRESS

SIGNATURE OF OFFICER

WITNESS

18-11643