Preview
AO S/H 9S
2a.mm 34uANS
MARSY'SLAWINVOKED § PoAH/Y {
Confidential Info Containee
‘OBTS Number
ARREST | NOTICE TO APPEAR
Lamea 3 Reamattrwaran [4 | 2 [AY
Juvenile Referral Report ZINTA 4. Request tor Capias
g | Rooney ORTNumber “Agency Name ‘gency Report Number
e FLO500300 BOYNTON BEACH POLICE DEPT. 34-22-005177
£ ‘Charge Type: 1 1. Felony. 3. Misdemeanor 5. Ordinance: TH Weapon Selzed Enter Type. Te
| Check as many as Apply. ee D4. Trame Misdemeanor OI Sots Reese
3 | Tocaton of Arent Wrdicing Name oF eee Bante Naina, RETO
<1191 Hemming Way, Boynton ‘Beach, FL 33426 hot Hi Hemming Way, Boynton | Beach, FL 33426
Date Aree "Tere ofAroat 39 Dats] Booking Tene TaD Ta Tine Tocaton of Vetide
[05/08/2022 11608 |
Rane (Cait Fink Wado) “Hiax (ae, BOB, S2e, SOET, Eley
Eloi, Jean, Reginald
face ox Date of Bh Weight Color ‘Color Ce Bulls
Se een aan B | M |06/04/1987 5'9" N74 own lack idark [medium
‘Sears, Marka, Tatoos. Unique Features (Location, Type, Be Vartal Stats Trdication oF YN Uric
larried none oe ea
3 Tocal i (Street, Apt Number) ‘Ciatay Tey Prone ‘Type
#191 ae Way. £ Soren Beach, FL33 33426 (66157-9671 | 3 Bay cone Stale 1
8 TST aT Prone “Aaerees Source
194 191 Hemming Wa Way, y Boynton Beach, FL 33. 33426 (561)577-9671__jonsite
Business: (Steet Apt Number) THY ey ‘Prone
- butcher
Dimer, Sie TRS Raber FB ‘Chiara
IE400-476-87-204-0, FL i” Jysatos, Haiti immigrant
| come Name (Last, First, Midi) Date of Bit (D1. Arrested 13. Felony D5. Juvenile
8 D2 Allerg 114 Medemeanor
1G | CoBetendent Name Cant Frat Mioy | Date abe i Arata Fay ES ane
7 al) Bi xume Bi tetnee
T Parent ame (Lat) WU (Mice) Prone:
Legal
Done
A NOTIFICA
within 2. TOT HRS/OYS,
3. treercerated
REQ|
3 eee y_ Vv
3 iP I
a es ann was roan Wy Year andr [eats patria Gia me para we IT Tap He Jas | SwaT Aaa oar
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Tver, By rar fi. tear)
Sree | ONT Valo ol Proper
eo
rN ae ‘S. Son R. Smuggie ‘K Dispense’ W Manutacture 2 Other ‘Drug Type 'B. Barbituate ~~ H Hallucinogen:
nwa Bey Bouse Okebe oa! xWa i Martone
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aie % =
¥|bimple Battery (domestic) i [faves no [784.03(1)(a)
Aca ‘rug Type “AmounvOnit ‘Warranvcapias Number
kK Nix |22-005177
Charge Vi Sia
[Bites Ne
aaa a = Wararaaag Nba
Cane CTT ame Viens] Sas VRS NBT
[Gva* Gre
Activity | Drug Type ee fet wCapias Number
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9 Se ala Wea?
{peepee omar saan — —
Tr arcton Ne Toeation (Court Rom Nomber, sro : $n
S| Meeten mtewre can South County Courthouse, 200 West Atlantic Ave, Delray Beach, FL33444
south County Courthouse, 200 Wes Atlantic Ave,DelayBeach,FLasees {7
S| Eonpy wan iteatonen reverse nae. eh ct Dey Your ime DAM oem
e OFRERSECARCED TESUESC OU VERT
ij | WOPEAR aEPOne tHe COURT As REGUIRED BY THIS NORGE TO APPEAR THAT MAY 8€ FELD N CONTEMPT OF COURT AND A WARRANT FOR MY ARREST SHALL BE ISSUED.
2 ‘Signature of Defendant (or hivende and Parenioasoden 5 Data Signed
HOLD for othee Agency wc eeieat Sa ‘Name Verticaton (Printed by iy
‘Name: (PRINT).
2 [Doengerous ]_Resited Arest Rams ¢ffifresing Toe
3| Asyest Ox Ofc AVEichorst 971 BU# Page
> Routh # | Transporting Oficer Tor “Rooney 4 OF 4
LI Mek l loge, WERTMAN iit BPD _| Sinedwth an.
OCOANAIRD
SCANNELL
May Bury
MAY 09 2022i Mei jonni Sha
le,
is form m i fal ibe fei lowin; erin lay Wy ¢
This form must bon Flan tl iberfen Een tif éyowine Inte 6 Vonee,
- Homicide (Ch. 782) - Sexual Offense (Ch. 794) ty, ii
- Attempted Murder - Attempted Sexual Offense Magf |
- Stalking (S. 784.084) a
- Domestic Violence (This includes any Assault, Agg. Assault, Battery, Agg. Battery, 9
Sexual Assault, Sexual Battery, Stalking, Agg. Stalking or any criminal offense resulting m
in physical injury or death of one family member or household member by another, who Zz
is or was residing in the same dwelling) 9
a
Upon completion, this form must accompany the booking paperwork. If applying for a warrant, attach
this form to the filing packet. m
2.
1. Incident Report #:, 22-005177 Agency: Boynton Beach Police Department a
Offense: Simple Battery (domestic) @
Suspect/Offender-Eloi, Jean, Reginald 2
DOB: 06/04/1987 Race: B Sex: M 7
a
2 Warrant # (s): io
3. Complete one (1) of the following: D
A. Vietim’sName: _Marsy's Low ___ [a a
A
City: State. FL > —
Wo One:
B. Victim's Next of Kin: __None provided
Address: 7 a
City: State: Zip: »O
Home #: Work #: Other: =S
ra
G Victim's designated contact other than next of kin (for example: a friend or neighbor): a 9
Name: _none provided Bun
Address: 4 QR
City: State: Zip: w
Homes: Work #: Other, & =
ma
4. Relevant identification or case numbers assigned to the case (please specify): 3 3
22-20 §!9% £2
s3
WAIVER: I CHOOSE NOT TO COMPLETE THIS VICTIM NOTIFICATION FORM, AND
|UNDERSTAND THAT I AM WAIVING MY RIGHT TO BE NOTIFIED OF THE RELEASE OF THE)
|SUSPECT/OFFENDER.
Signature of Victim:
Printed Name of Victim: Marsy's Law
Officer's Name:Ofc A. Eichorst LO# 971 date: / /MARSY’S LAW INVOKED
Confidential Info Contained
DOMESTIC VIOLENCE PROBABLE CAUSE AFFIDAVIT
PALM BEACH COUNTY
Onthe 8th dayof May 2022 at 1608
Subject: Eloi, Jean, Reginald Dos; 06/04/1987 Case #; 22-005177
Charge Description: Simple Battery (domestic) Statute #: 784.03(1)(a)
Victim: Marsy's Law Dos: Race: Sex:
Local Address: Marsy's Law . oH
Personal Contact: None provided
Narrative:
The following incident occurred in the City of Boynton Beach, Palm Beach County, Florida:
On 05/08/2022 at approximately 1549 hours, | responded to EN in reference to a domestic
disturbance. Upon arrival, | made contact with the victim (Marsy's Law invoked) and the defendant, Jean
Reginald Eloi DOB 06/04/1987. The victim was crying and advised that Eloi struck her in the face. | advised
the victim that paramedics were on the way to provide her medical care. | advised the victim that other
officers were on the way, as | was already in contact with Eloi in the driveway. | was unable to make
contact with the victim right away, as | did not want to provide Eloi an opportunity to leave the scene.
Eloi advised that he and his Il (the victim) were in a verbal argument over their vehicle. He stated that
while they were arguing, the argument became “heated” and he pushed her. He stated that he does not
know why the victim needed to call the police, as they were only arguing. While speaking with Eloi, other
Officers arrived on scene and | was then able to make contact with the victim.
Upon making contact with the victim, | observed swelling, redness, and a small laceration on the left side of
the victim's face. | also observed redness further back on the left side of the victim's head which could be
‘seen through her hair. The victim also had redness and swelling on the right side of her face and a red
bruised area on the inside of her left forearm.
The victim advised that she and Eloi were in a verbal argument over the use of the vehicle. She advised
that she was working since 0500 hours this morning and was trying to make food for herself in the kitchen
while they were arguing. During the argument, she yelled to Eloi “Leave me alone, I’m hungry,” at which
point he grabbed her by the shirt and began to punch her in the face with a closed fist. She stated that Eloi
continued to punch her, causing her to fall down onto the kitchen floor. After she fell, the victim stated that
Eloi continued to punch her in her face while she was on the floor. After Eloi stopped striking her in the
face, the victim advised that she called 911. The victim advised that she does not know how many times
Eloi struck her in the face, but stated it was more than twenty times.
The victim's EE (who is also Eloi’s INN advised that she witnessed the altercation. The
child advised that she heard the argument in the kitchen between her HNL During the verbal
argument, she stated she heard a slap. She then walked into the kitchen and observed Eloi punching the
victim in the face. The child was not harmed during the incident. A secondary investigation was conducted
for child abuse. The home was clean, had running water, electricity, and air conditioning. There was ample
food in the kitchen/refrigerator and the child was wearing clean clothing and appeared to be in good spirits.
despite the incident that had just occurred.
Eloi was later placed into handcuffs to the rear, with the cuffs checked for proper spacing and double
locked. He was then read his Miranda Rights by Officer Thomas, which Eloi advised he understood and
later signed the Miranda card. Post Miranda, Eloi stated to Officer Thomas that he and the victim were ina
verbal argument over their vehicle. During the argument, Eloi advised he began to throw cups at the victim
while in the kitchen. After throwing cups at the victim, Eloi stated that the victim began to swing at him, at
which point he slapped her in the face.
Based on the above stated facts, Probable Cause was established to charge Jean Reginald Eloi with one
count of domestic battery in violation of Florida State Statute 784.03(1)(a). Eloi was transported to the
Boynton Beach Police Department and later transported to the Palm Beach County Jail. The victim was
advised that she would be contacted upon Eloi’s release. She advised that after he is released, he canLAW INVOKED
4 wiiciontial info Contained
return home, but that she “wants nothing to do with him.” | advised the victim that she is able to
communicate with the courts to determine the outcome of the arrest. A copy of the master recording was
requested. The DCF Law Enforcement hotline was contact and DCF Employee Vie ID 256 advised a report
would be generated.
Defendant's Statement: Taped Victim's Statement: Taped
Observation Of Victim (Physical and Emotional):
Crying, frantic, bruising and redness/swelling on face and arm
Relationship Between Victim and Suspect:
EsMARSY’S LAW INVOKED
Confidential info Contained
Photographs: Scene: []Yes [JNo
Victim: [m]Yes [)No
911 Call: [MlYes [[JNo Caller, Victim
Tape Requested: [Yes [No
Weapon Used: [Yes {JNo Type:
Witnesses: fMYes [No
Injuries: [Yes [No
Medical Treatment: Yes [No
AtScene [Yes [[JNo_ Paramedics: Boynton Beach Fire Rescue
At Hospital Les [No Physician(s):
Hospital:
Act Committed In Presence Of Minor(s): [li] Yes (No
Name: Yolanda Eloi Age 7
Name: Age:
F.D.CF.Notified: [mJYes [JNo Victim Pregnant: []¥es [im] No
Violation Of Restraining Order: Oves [JNo Case #:
Prior History Of Domestic Violence: []Yes __[M]No
Alcohol Or Drugs Involved: Ores [HJNo (unknown
Victim Contact Information:
Phone Home: Work:
Employer:
Relative Name: none provided Phone:
Address:
City/State: oot
State Of Florida
County Of Palm Beach
Appeared beforeme, Ofc A.Eichorst _, (print name) personally known to me, who, being first duly sworn, says that
the facts above, based upon my investigation, are true.
Sworn to and subscribed to me before this 8th dayof May , 2022<@y SHERIFF'S OFFICE . Se
* ‘Horida State Statute Exemption Sheet
Palm Beach County Sheriff’s Office - Arrests Only
x Florida State Statute Description Page Number(s)
a Surveillance techniques, procedures and personnel, inventory of law enforcement resources, policies or plans
a 119.071(2)14) : re :
pertaining to mobilization deployment or tactical operation:
g]c 943.053, 943,0525 NCIC/FCIC/FBI and in-state FDLE/DOC.
3
gla 119.071(4)(c) Undercover personnel.
§yc 119.071(2)(6) Confidential informants (Cis).
a 119.071(2\(e) Confession.
2 985.04(1) Juvenile offender records.
g
z 119.071(h\(i) ‘Assets of a crime victim.
&T- 395.3025(7)(al,
Sie ase pea Medical information,
z 394.4615(7) Mental health information.
3
2 i i i 7
ets aaoieladelas Home address, telephone, Social Security number, date of birth, or photos of active/former LE personnel,
spouses, and children.
= iy Toute Social Security, bank account, charge, debit, and credit card numbers. 2
Qo (vill) 394.4615(7) Clinicat records under the Baker Act.
&]a (xii) 741.30(3)(b) ‘The victim’s address in a domestic violence action on petitioner's request.
5
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REVIEW COMPLETED BY
Booking Number: 2022012028
Date: 5/9/2022
Specialist Name/ID: M. Tooks #8557
Preview
AO S/H 9S 2a.mm 34uANS MARSY'SLAWINVOKED § PoAH/Y { Confidential Info Containee ‘OBTS Number ARREST | NOTICE TO APPEAR Lamea 3 Reamattrwaran [4 | 2 [AY Juvenile Referral Report ZINTA 4. Request tor Capias g | Rooney ORTNumber “Agency Name ‘gency Report Number e FLO500300 BOYNTON BEACH POLICE DEPT. 34-22-005177 £ ‘Charge Type: 1 1. Felony. 3. Misdemeanor 5. Ordinance: TH Weapon Selzed Enter Type. Te | Check as many as Apply. ee D4. Trame Misdemeanor OI Sots Reese 3 | Tocaton of Arent Wrdicing Name oF eee Bante Naina, RETO <1191 Hemming Way, Boynton ‘Beach, FL 33426 hot Hi Hemming Way, Boynton | Beach, FL 33426 Date Aree "Tere ofAroat 39 Dats] Booking Tene TaD Ta Tine Tocaton of Vetide [05/08/2022 11608 | Rane (Cait Fink Wado) “Hiax (ae, BOB, S2e, SOET, Eley Eloi, Jean, Reginald face ox Date of Bh Weight Color ‘Color Ce Bulls Se een aan B | M |06/04/1987 5'9" N74 own lack idark [medium ‘Sears, Marka, Tatoos. Unique Features (Location, Type, Be Vartal Stats Trdication oF YN Uric larried none oe ea 3 Tocal i (Street, Apt Number) ‘Ciatay Tey Prone ‘Type #191 ae Way. £ Soren Beach, FL33 33426 (66157-9671 | 3 Bay cone Stale 1 8 TST aT Prone “Aaerees Source 194 191 Hemming Wa Way, y Boynton Beach, FL 33. 33426 (561)577-9671__jonsite Business: (Steet Apt Number) THY ey ‘Prone - butcher Dimer, Sie TRS Raber FB ‘Chiara IE400-476-87-204-0, FL i” Jysatos, Haiti immigrant | come Name (Last, First, Midi) Date of Bit (D1. Arrested 13. Felony D5. Juvenile 8 D2 Allerg 114 Medemeanor 1G | CoBetendent Name Cant Frat Mioy | Date abe i Arata Fay ES ane 7 al) Bi xume Bi tetnee T Parent ame (Lat) WU (Mice) Prone: Legal Done A NOTIFICA within 2. TOT HRS/OYS, 3. treercerated REQ| 3 eee y_ Vv 3 iP I a es ann was roan Wy Year andr [eats patria Gia me para we IT Tap He Jas | SwaT Aaa oar Cout Gat» Ofce (Poe 31 2560220) ormed of eny cheng of adress Tver, By rar fi. tear) Sree | ONT Valo ol Proper eo rN ae ‘S. Son R. Smuggie ‘K Dispense’ W Manutacture 2 Other ‘Drug Type 'B. Barbituate ~~ H Hallucinogen: nwa Bey Bouse Okebe oa! xWa i Martone PrPoweess Tete E-Use Caete KAmhwonine Eran” ©. aie % = ¥|bimple Battery (domestic) i [faves no [784.03(1)(a) Aca ‘rug Type “AmounvOnit ‘Warranvcapias Number kK Nix |22-005177 Charge Vi Sia [Bites Ne aaa a = Wararaaag Nba Cane CTT ame Viens] Sas VRS NBT [Gva* Gre Activity | Drug Type ee fet wCapias Number a Data Domest vem] Siti 9 Se ala Wea? {peepee omar saan — — Tr arcton Ne Toeation (Court Rom Nomber, sro : $n S| Meeten mtewre can South County Courthouse, 200 West Atlantic Ave, Delray Beach, FL33444 south County Courthouse, 200 Wes Atlantic Ave,DelayBeach,FLasees {7 S| Eonpy wan iteatonen reverse nae. eh ct Dey Your ime DAM oem e OFRERSECARCED TESUESC OU VERT ij | WOPEAR aEPOne tHe COURT As REGUIRED BY THIS NORGE TO APPEAR THAT MAY 8€ FELD N CONTEMPT OF COURT AND A WARRANT FOR MY ARREST SHALL BE ISSUED. 2 ‘Signature of Defendant (or hivende and Parenioasoden 5 Data Signed HOLD for othee Agency wc eeieat Sa ‘Name Verticaton (Printed by iy ‘Name: (PRINT). 2 [Doengerous ]_Resited Arest Rams ¢ffifresing Toe 3| Asyest Ox Ofc AVEichorst 971 BU# Page > Routh # | Transporting Oficer Tor “Rooney 4 OF 4 LI Mek l loge, WERTMAN iit BPD _| Sinedwth an. OCOANAIRD SCANNELL May Bury MAY 09 2022i Mei jonni Sha le, is form m i fal ibe fei lowin; erin lay Wy ¢ This form must bon Flan tl iberfen Een tif éyowine Inte 6 Vonee, - Homicide (Ch. 782) - Sexual Offense (Ch. 794) ty, ii - Attempted Murder - Attempted Sexual Offense Magf | - Stalking (S. 784.084) a - Domestic Violence (This includes any Assault, Agg. Assault, Battery, Agg. Battery, 9 Sexual Assault, Sexual Battery, Stalking, Agg. Stalking or any criminal offense resulting m in physical injury or death of one family member or household member by another, who Zz is or was residing in the same dwelling) 9 a Upon completion, this form must accompany the booking paperwork. If applying for a warrant, attach this form to the filing packet. m 2. 1. Incident Report #:, 22-005177 Agency: Boynton Beach Police Department a Offense: Simple Battery (domestic) @ Suspect/Offender-Eloi, Jean, Reginald 2 DOB: 06/04/1987 Race: B Sex: M 7 a 2 Warrant # (s): io 3. Complete one (1) of the following: D A. Vietim’sName: _Marsy's Low ___ [a a A City: State. FL > — Wo One: B. Victim's Next of Kin: __None provided Address: 7 a City: State: Zip: »O Home #: Work #: Other: =S ra G Victim's designated contact other than next of kin (for example: a friend or neighbor): a 9 Name: _none provided Bun Address: 4 QR City: State: Zip: w Homes: Work #: Other, & = ma 4. Relevant identification or case numbers assigned to the case (please specify): 3 3 22-20 §!9% £2 s3 WAIVER: I CHOOSE NOT TO COMPLETE THIS VICTIM NOTIFICATION FORM, AND |UNDERSTAND THAT I AM WAIVING MY RIGHT TO BE NOTIFIED OF THE RELEASE OF THE) |SUSPECT/OFFENDER. Signature of Victim: Printed Name of Victim: Marsy's Law Officer's Name:Ofc A. Eichorst LO# 971 date: / /MARSY’S LAW INVOKED Confidential Info Contained DOMESTIC VIOLENCE PROBABLE CAUSE AFFIDAVIT PALM BEACH COUNTY Onthe 8th dayof May 2022 at 1608 Subject: Eloi, Jean, Reginald Dos; 06/04/1987 Case #; 22-005177 Charge Description: Simple Battery (domestic) Statute #: 784.03(1)(a) Victim: Marsy's Law Dos: Race: Sex: Local Address: Marsy's Law . oH Personal Contact: None provided Narrative: The following incident occurred in the City of Boynton Beach, Palm Beach County, Florida: On 05/08/2022 at approximately 1549 hours, | responded to EN in reference to a domestic disturbance. Upon arrival, | made contact with the victim (Marsy's Law invoked) and the defendant, Jean Reginald Eloi DOB 06/04/1987. The victim was crying and advised that Eloi struck her in the face. | advised the victim that paramedics were on the way to provide her medical care. | advised the victim that other officers were on the way, as | was already in contact with Eloi in the driveway. | was unable to make contact with the victim right away, as | did not want to provide Eloi an opportunity to leave the scene. Eloi advised that he and his Il (the victim) were in a verbal argument over their vehicle. He stated that while they were arguing, the argument became “heated” and he pushed her. He stated that he does not know why the victim needed to call the police, as they were only arguing. While speaking with Eloi, other Officers arrived on scene and | was then able to make contact with the victim. Upon making contact with the victim, | observed swelling, redness, and a small laceration on the left side of the victim's face. | also observed redness further back on the left side of the victim's head which could be ‘seen through her hair. The victim also had redness and swelling on the right side of her face and a red bruised area on the inside of her left forearm. The victim advised that she and Eloi were in a verbal argument over the use of the vehicle. She advised that she was working since 0500 hours this morning and was trying to make food for herself in the kitchen while they were arguing. During the argument, she yelled to Eloi “Leave me alone, I’m hungry,” at which point he grabbed her by the shirt and began to punch her in the face with a closed fist. She stated that Eloi continued to punch her, causing her to fall down onto the kitchen floor. After she fell, the victim stated that Eloi continued to punch her in her face while she was on the floor. After Eloi stopped striking her in the face, the victim advised that she called 911. The victim advised that she does not know how many times Eloi struck her in the face, but stated it was more than twenty times. The victim's EE (who is also Eloi’s INN advised that she witnessed the altercation. The child advised that she heard the argument in the kitchen between her HNL During the verbal argument, she stated she heard a slap. She then walked into the kitchen and observed Eloi punching the victim in the face. The child was not harmed during the incident. A secondary investigation was conducted for child abuse. The home was clean, had running water, electricity, and air conditioning. There was ample food in the kitchen/refrigerator and the child was wearing clean clothing and appeared to be in good spirits. despite the incident that had just occurred. Eloi was later placed into handcuffs to the rear, with the cuffs checked for proper spacing and double locked. He was then read his Miranda Rights by Officer Thomas, which Eloi advised he understood and later signed the Miranda card. Post Miranda, Eloi stated to Officer Thomas that he and the victim were ina verbal argument over their vehicle. During the argument, Eloi advised he began to throw cups at the victim while in the kitchen. After throwing cups at the victim, Eloi stated that the victim began to swing at him, at which point he slapped her in the face. Based on the above stated facts, Probable Cause was established to charge Jean Reginald Eloi with one count of domestic battery in violation of Florida State Statute 784.03(1)(a). Eloi was transported to the Boynton Beach Police Department and later transported to the Palm Beach County Jail. The victim was advised that she would be contacted upon Eloi’s release. She advised that after he is released, he canLAW INVOKED 4 wiiciontial info Contained return home, but that she “wants nothing to do with him.” | advised the victim that she is able to communicate with the courts to determine the outcome of the arrest. A copy of the master recording was requested. The DCF Law Enforcement hotline was contact and DCF Employee Vie ID 256 advised a report would be generated. Defendant's Statement: Taped Victim's Statement: Taped Observation Of Victim (Physical and Emotional): Crying, frantic, bruising and redness/swelling on face and arm Relationship Between Victim and Suspect: EsMARSY’S LAW INVOKED Confidential info Contained Photographs: Scene: []Yes [JNo Victim: [m]Yes [)No 911 Call: [MlYes [[JNo Caller, Victim Tape Requested: [Yes [No Weapon Used: [Yes {JNo Type: Witnesses: fMYes [No Injuries: [Yes [No Medical Treatment: Yes [No AtScene [Yes [[JNo_ Paramedics: Boynton Beach Fire Rescue At Hospital Les [No Physician(s): Hospital: Act Committed In Presence Of Minor(s): [li] Yes (No Name: Yolanda Eloi Age 7 Name: Age: F.D.CF.Notified: [mJYes [JNo Victim Pregnant: []¥es [im] No Violation Of Restraining Order: Oves [JNo Case #: Prior History Of Domestic Violence: []Yes __[M]No Alcohol Or Drugs Involved: Ores [HJNo (unknown Victim Contact Information: Phone Home: Work: Employer: Relative Name: none provided Phone: Address: City/State: oot State Of Florida County Of Palm Beach Appeared beforeme, Ofc A.Eichorst _, (print name) personally known to me, who, being first duly sworn, says that the facts above, based upon my investigation, are true. Sworn to and subscribed to me before this 8th dayof May , 2022<@y SHERIFF'S OFFICE . Se * ‘Horida State Statute Exemption Sheet Palm Beach County Sheriff’s Office - Arrests Only x Florida State Statute Description Page Number(s) a Surveillance techniques, procedures and personnel, inventory of law enforcement resources, policies or plans a 119.071(2)14) : re : pertaining to mobilization deployment or tactical operation: g]c 943.053, 943,0525 NCIC/FCIC/FBI and in-state FDLE/DOC. 3 gla 119.071(4)(c) Undercover personnel. §yc 119.071(2)(6) Confidential informants (Cis). a 119.071(2\(e) Confession. 2 985.04(1) Juvenile offender records. g z 119.071(h\(i) ‘Assets of a crime victim. &T- 395.3025(7)(al, Sie ase pea Medical information, z 394.4615(7) Mental health information. 3 2 i i i 7 ets aaoieladelas Home address, telephone, Social Security number, date of birth, or photos of active/former LE personnel, spouses, and children. = iy Toute Social Security, bank account, charge, debit, and credit card numbers. 2 Qo (vill) 394.4615(7) Clinicat records under the Baker Act. &]a (xii) 741.30(3)(b) ‘The victim’s address in a domestic violence action on petitioner's request. 5 [a | PRBBOREIR, | proteesixmaton gun cine odd abus or eal fenses e a g s —e|o z 2 3 2]o . 2 $]0 8 z a Other: i éle Other: REVIEW COMPLETED BY Booking Number: 2022012028 Date: 5/9/2022 Specialist Name/ID: M. Tooks #8557