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OrLANDO POLICe DEPARTmEnT Case #: 03hD( 2805 Date of Month:I Z DayigI Year? Statement Statement: nre Please till out in full detail Date of Month: Year: b6 Offense: District:g _ 2 b7C Location of Offense: Durk Centey Cs. -tashiorKoct Person Code: Age: Res. Address Bust Type of ID shown: , do herby voluntarily make the following statement Winour mnreal, coercion, offer of benefit, or favor by any persons whomsoever.. receispg.cull. fom 3.0.02303 b6 b7C I eyphiaed snecfis' asost. refonl anlshn he needaitoonkt Aswt teahterhod ergne. yery irrc+e an.h StlcX he wss(ohj Suldioy h.m heussmkuy sthect he Suyes LOMNA Urb iioswll wotbe toeietomow I then Aoreeleh tcod the phane.ccl) 4 T. O+e ohore. hercxehe idento haself ctA.e.. Seioiast toe (onsersshi6. b6 b7C distilie- tp iecasnite. Sdl Host he peedeht contset 9q backe.hct i b7C DA Ad Ahitle. cAu demino Aie his thalt yery Seriousto myself and Qunpnyet. Hlt. yeryditrsel.sd Ahsng iall Ldnicbiswhy. 3 Acaccedes uits. reyowain, the treat. Swom to and suhscribed belore me. this ?. L.day ot! Lswear/affirmthe.above-and/or-attached-statements-are-correct .and.true... Notary Puglic Law Entorcement Onicer Name Key b6 Produced Identification Signature Personally Known Type_ b7C My signature balow means that I retuse to prosecute the person(s) named above. Victim Rights Booklet provided EseA No for the alleged crime(s) that occurred to me or to the property under my control. I wll testify in court and prosecute criminally. Initials Signature Miranda Warning Read? Date Yes WEON Pageof _ (Departmental policy prohibits use of this section (n domestic violence cases.) OP-36C- 01/21/02 White: State Attoney Yellow: Records Pink: Investigator. Green: Victim 17C+Pb3$29-2