1.
TYPE
OFFENSE/INCIDENT REPORT
INSTRUCTIONS ARE PRINTED SEPARATELY. IF ADDITIONAL SPACE
IS NEEDED, USE REVERSE OF FORM; IDENTIFY ITEMS.
2. CODE NO.
2a. SORT
42363
a. ORIGINAL
b. CONTINUATION
3. TYPE OF OFFENSE OR INCIDENT
4. CASE CONTROL NUMBER
overdose
73gg4
5. BUILDING NUMBER
c. SUPPLEMENT
OR FOLLOWUP
523262372
6. ADDRESS
13425
13300 S Elm Street
7. NAME OF AGENCY/BUREAU
8. AGENCY/BUREAU CODE
FAKE
9. SPECIFIC LOCATION
16629
11a. DATE OF OFFENSE/INCIDENT
10. LOCATION CODE
1234 S Lubert Dr
11a. TIME OF OFFENSE/INCIDENT
12-25-14
12:00p.m
12.
DAY
13a. DATE REPORTED
13b. TIME REPORTED
12-26-15
7:00 a.m
14. DAY
Sunday
Tue
s
15. JURISDICTION (X)
VEDINVOLNSPERSO18.
EXCLUSIVE
ID
CODE
(a)
62b
16. NO. OF DEMONSTRATORS
CONCURRENT
PARTIAL
PROPRIETARY
17. NO.
EVACUATED
0
NAME AND ADDRESS
(b)
Last Name, First, Middle Initial
Mike Wazowski
AGE
(c)
SE
X
(d)
RA
CE
(e)
INJURY
CODE
(f)
TELEPHON
E
(g)
HOME
BUSINESS
Consuela Velasquez
Number, Street, Apt. No., City and State
19. VEHICLE
STOLEN
c. MAKE
GOVT
PERSONAL
VANDALIZ
ED
RECOVERED
e. COLOR (Top/Bottom)
f. IDENTIFYING CHARACTERISTICS
g.
REGISTRATIO
N
d.
MOD
EL
SUSPECT
STAT
E
TAG
NO.
h. VIN
i. VALUE
a. NAME OF ITEM
b. QUANTITY
e. SERIAL NO.
f. COLOR
g. MODEL
i. UNUSUAL OR UNIQUE FEATURES
j. PROPERTY WAS
k. STATUS OF PROPERTY
RECOVERED
c. OWNERSHIP
GOVT
h. VALUE
SECURRED
UNSECURED
MISSING
PERSONAL
d. BRAND NAME
VALUE RECOVERED
PARTIAL RECOVERY
l. NAME OF ITEM
m. QUANTITY
p. SERIAL NO.
q. COLOR
r. MODEL
t. UNUSUAL OR UNIQUE FEATURES
u. PROPERTY WAS
v. STATUS OF PROPERTY
RECOVERED
n. OWNERSHIP
GOVT
s. VALUE
SECURRED
UNSECURED
b.
YEAR
a. STATUS
HOME
BUSINESS
YEAR
TAKEN 20. ITEMS
3;45
1300 S Elm Street
1523 Oak Ave
b. TIME END
Number, Street, Apt. No., City and State
Last Name, First, Middle Initial
a. TIME START
7:22
MISSING
PERSONAL
PARTIAL RECOVERY
o. BRAND NAME
VALUE RECOVERED
21. NARRATIVE (If additional space is needed, use blank sheet and attach.)
Man overdosed on pills . Maid found him on the ground this morning at 7. Trying to contact wife and kids.
GENERAL SERVICES ADMINISTRATION
23a. EVIDENCE
TIME
22. NOTIFICATION
NOTIFIED
YES
ARRIVED
a. Other Police
Agency
b. Fire Department
yes
c. Ambulance
GSA FORM 3155 (REV. 3/200)
NO
23b. TAG NO.
23c. TYPE
23d. WHERE STORED
on the floor in the bedroom
24. ATTACHMENTS (Mark X where applicable)
a. CONTINUATION SHEET
b. GSA FORM 3157
c. PROPERTY RECEIPT(S)
e. SUPPLEMENTAL
e. OTHER (Specify)
25. SUSPECT STATUS
a. NOT IDENTIFIED
b. GOVERNMENT EMPLOYEE
c. GOVERNMENT CONTRACT
26. DISPOSITION OF SUSPECT
a. ARRESTED
c. RELEASED
d. CITATION ISSUED
b. NOT ARRESTED
d. N/A
CITATION NUMBER
d. NON-GOVERNMENT EMPLOYEE
d. STATEMENT(S) X
f. OTHER ATTACHMENTS (Specify)
d. Building Manager
e. N/A
NOTE: Complete GSA Form 3157 where this is a Suspect, Att. Burglary, Burglary, Att. Robbery, Robbery, or a Weapon is used.
27. TIME
a. RECEIVED
28. REVIEWED BY
b. ARRIVED
a. TYPE
FPS
c. RETURNED TO SERVICE
29a. BADGE
b. SIGNATURE
d. DATE
c. NAME (Printed)
GG
29b. NAME (Printed)
29c. SIGNATURE
29d. DATE
30. CASE REFERRED TO
a. FPS
DETECTIVE
b. LOCAL
POLICE
d. FBI
e. IG
31. CASE
c. STATE POLICE
32. APPROVING OFFICIAL
a. SIGNATURE
a. OPEN
g. OTHER (Specify)
b. CLOSED
c. NAME (Printed)
c. UNFOUNDED
f. N/A
b. DATE
33. DETECTIVE STATUS
a. CASE NUMBER
b. HOW CLOSED
INACTIVE
MEANS
c. SUSPECT
ARREST
OTHER
f. VALUE OF PROPERTY
e. PROPERTY
RECOVERED
d. ENTERED NCIC
DEVELOPED
ARRESTED
g. CLEARED NCIC
YES
h. REFERRED TO
YES
NO
N/A
i. DATE REFERRAL ACCEPTED
21. NARRATIVE (If additional space is needed, use blank sheet and attach.)
NO
N/A
GSA FORM 3155 (REV. 3/200) PAGE 2
