ARREST REPORT - INITIATING CASE

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Agency Case # 220100357 Arrest Affidavit
Use separate forms for each defendant and for multiple offenses occurring at different time, date or location C1 Juvenile
Court Case # Copy To: Clerk of Court / State Attorney / Jail / Arresting Agency / Defendants
(1 Warrant
[Detendantbata Tae mo mas Te]
[Crawford | [Mary | [Eizabetn | | [77 940-2611 | [07/26/1062] [30 | | | [Feats]
Last Name First Name Middle Name Aliases (A.K.A.) Phone Number Date of Birth Age SSN Gender
[6531-5 N Us Highway 1 | [Fort Pierce ] [Fe] [s4046___] [ostesaseaeso | [ Fx | [united states |
Permanent Address iy State Zp Drivers License # State Citizenship
[white | [Bond or ][Brown | [505 Jo IE il

 

Race Hair Color Eye Color Height Weight Distinguishing Marks ‘Occupation / Employer / Schoo}
[Arrest Information. eae ae mE

 

    

 
   

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[220100367 I Dames, Milton A | [Fon Pierce Police Department ] oe ] [No ]
Agency Case # Offi…