Preview
Filing # 189138324 E-Filed 01/04/2024 08:15:58 PM
a ay
FORM | On View PC Arrest) x
PURPOSE Capias Request rh ¥E5 ae nox
| PROBABLE CAUSE AFFIDAVIT
a Taken nto Custody (Warean/Capias Arrest) Summoned (Cited (NTA Referral ivi Citation
[arresting Agency O8i Number Tarrenting Agency Name Rvesting Rgercy Cova) Rivest Namibee JORTE Number
051200
| CITY OF PALM BAY POLICE DEPARTMENT
__PS0)-
| Booking Agency6 ORI
Yes)
24-000102
FOUE Namber anspor iat Dateline -
.
FB Nomber BOC Rumber
Tene [ail Booking Nomber
Location of Arvest (include Name of Susiness) oy
VY@Y/2-3 1909 2Y-co009/:
Seation of Offense finclade Narve af Business ~
ay
a
:
cS 1156 Alpine Ave NW City of Palm Bay 1156 Alpine Ave NW City of Palm Bay
Bieri ie BR ie Hanae reer (Charge Type elect ss mary as apply) Felony [Evidence Contiscated (Select as many ax anni)
01/04/2024 61/04/2024 14:47 Misdemeancr trate Ordinance Vehicle Fieeneem Property
sn a
a
Name (Last, First, Middle) Bike and Type Bacot anh ee acket Worber
Whidden, Ryan, John 07/31/1988 35 SPPF VS
Jisce inci ee Height ie Eye tier frais Color
White N/A Male 59 150 Ibs Biue Black
Sears, Marks, Tattoos, Unique Physical Features (location, Type, Besciiplon)
.
None
(ocal Address treet, Apt. Numbers
Homeless
Git. State, ip aa TA aa rimacy tangas Enatsh OC
N/A
bee Permanent Address (Siveet, Ant. Numbeil
or parents huvenile ~
— Gay State, Bp Phone/iype linclade area cade) [Complexion
3 : (Same as Address) Light
Bosiness Address (Street, Apt Number) Gy, Sate, Zin riage Tsk we eae aid
Stim
Briers \icense Stata/ Nomber/ Type Social Security Number ins Naber Place af inh a
enna
FL/W350730882710/E United States of America
Residence type. iaark Ai that Apply W, N, Get) Sespect of Using (¥,N Unk) Drugs N
ity DE County Florida Outot State Homeless ¥ Sex offender ® Gang Affiliation W Alcona N Computer? Handheld Device
PARENT Driver's License State / Number? Type [PARENT Social Security Number™ [iivenile Gril tation hot Relevved Explanation Tivenile Fachiny
“a
* Collection of social security numbers from an arrested indvidual isto veily identi dnd may be shared with other fae enforcement agencies.
Pe caps Warrant ‘Additional Charge Date issued onyajz024 Wet Aft ‘Bamestic Vislenen
me Grdes of Arrest
Charge Gescrtpion Couns 5 Statute) Ordinance Nomber ie ciasaier
Burglary a ona 310.02(3}(b)
Srug hetty [Bren Fyee Amounifint Baad Amount (Warrant / Chation / Court Number
5 $2000
-
“The tindersigned certifies and swears that he/ahe has just aed reasonable grounds to believe and does believe and does believe that the above ‘Gefendant committed the folowing wolation afiaw
Jonthe 4th day of rer a eer — AM xem ‘Speciicaiy incude fects constituting cause for arvast)
Ee
See attached narrative.
ie - Th accordance with € SS, 958 27, 1 hereby request “aimbursamont al ivestiguiive costs Consisting of iOS “perbr and/or ‘les@ ermine ora total ofS
Affidavit Artached:. wes OC no ~
a a
Continue for Narative XX chanees XX
Vacation oor Room Namie, Adare) Baare
Mandatory Appearance Viera Court House, 2825 judge Fran Jamieson Way, Viera, Fi 32940
in Court ate fone Ser Yeon ee
.
AGREE YO APPEAR AT THE TIME AND PLACE DESIGNATED TO.ANSWER THE OFFENSE CHARGED OR 10 PAY THE FINE SUBSCRIBED, | UNDERSTAND THAY SHOULD 1 WILLFUILY FAIL TO APPEAR BEFORE THE COURFAS REQUIRED
= a 8Y THIS NOTIVE TO APPEAR, THAT | MAY BE HELD IN CONTEMPT OF COURT AND A WARRANT FOR MY ARREST OR A TAKE INTO CUSTOOY ORDER SHAK BE ISSUED.
H Signatute of Gelendant / uvenile Signature of iuveniie’s Parent / Custodian Reivase to (Name) Gate Time
a hana
a
Noid for Other Agency [Werited 8 [Bo Not Bond Gut Remon
Name: old for tst Appearance (Adults Ory)
—
Swear(allirm the ubove and attached statements ave| Ofluers/ G lainant's Signature Digitally signed by Iszae Sean ioe Toiticer ‘leamagan ame Print ied
yueand correct 1DO on a gyaq isaac Dean ate: 2024.01.04 16:02-16-05'00 | 280
an la
|Ofc. t. Dean 1D#280
Swoin and ssbseribed belare me, the undersigned [Notary Signature Ristary Newwe Printed} arg Caw Enc Bie i Retarance
puthavity his cl oa teneiv trou 7 Dts
= " January Sergeant P. Farmer 10#215
Filing 189138324 VS 05-2024-CF-010390-ARR-BE
a
AGENCY NAME: CITY OF PALM BAY POLICE DEPARTMENT
— BREVARD COUNTY, FLORIDA, ‘Arresting Agency Case Number2
Continuation Page 2
Befendant/
vende Name (a, Fst Made) (OBTS Nomber
Whidden, Ryan, john aoe
a
[Gor Deterdan name fast, Fst, Middle} Race Sox Date of Birth or Age ioveniie TN)
Not Applicable
oe
Arcasted a artarge Chee | Felony Tica
So-Betendant nate Was Fst Maa) fiace Sew Bate of Binh or Age haven 7)
Not Applicable —
‘crested Ablange ites Felony Miademeanor
ee ‘aia Warrent asin arae ‘re haved Re “Tea
Chaige Descrpion oan OM
| wont
Statute? Ordinance Namber
voleoce aren
ine ciassfior
Criminal Mischief
a i ont 806.13{2)
rag Acting [Sse Tree [Amouat/Unie Bana aaa (Warrant
/ Citation / Coun Namber
$500
Caaias Wawra posters age te ase wean ‘Saree
Vilanoe arrest
charge Besertpion (counts * [Siatatey Ordinance Number Re classifier
De.
rag Ackiity Drop Type amount hint Bond Amount ~~ TWarrant/ Citation / Count Number
ae
cans warn ‘Adasen Charge I Date issued weit at Se
wees,
[Charge Bescrnpion Geant 5, Staite] Ordinance Nusiber ie casster
ontae
Brag Retvity Bie Fee famourefanit ‘Band Amount Warrant / Etation / Court Number
a
Fear make Model vn ag 7 Tag Siawe Primary Color [Secondary Color
*if Applicabie, provide information related
to the vehicle invelved in the crime.
(Officer sf Complainants Signature Digitally signed by Isaac Dean Tow [Officer s/amplainant's
Name (printed)
Isaac Dean Date: 2024.01.04 16:04:26 -05'00" 1280 Ofc. 1, Dean 1D#280
05-2024-CF-010390-AXXX-BC....
AGENCY NAME: CITY OF PALM BAY POLICE DEPARTMENT BREVARD cbunt, FLORIDA Agency Case Number
ene Ot
NARRATIVE: Continuation Page 3 of 4
Defendant /laverile Name fast, Firs, Masdie} a
BTS Hamnber
Whidden, Ryan, John
Caoiee wn ‘nessiona! uae [permed wena fe oa
eleroe
[Change Deseritpion reunes FS. [Statute] Ordinance Namber ie classter
or
Brag Atty Baie Tree Rrvourafonit ms ‘Amour Warrant] Chation) Gouct Number
me z‘aeiae ‘warart aaniene Chege [ame ‘we a IE
weience
‘aE
res
et
Charge Descrnpion Counts (Siatute/ Ordinance Namber Re cassie
ona
Brag Retivty aig Troe famouneann Bond Amount [Warrant 7 Gtation / Court Number
‘canae arene ‘aitione: Cheers [ese wae area aaron
Vance
charge Descripion Coats rs Statute) Ordinance Namber Re-classifir
Brug Activity Diag Wee fAmount/ini Bond Amount (Warrant 7 Gtation / Court Number
ane
On January 4th 2024, at approximately 1430 hours, | responded to 1156 Alpine Ave NW.
On 1-3-24 | went out to the residence for potential squatters. We located a smashed out back slider and signs of people squatters. The property
management Kimberly Lewis sent out a worker and had the back slider boarded up.
Kimberley called today and advised that their staff just went out to the residence and there is a person at the house again, Kimberly resounded to the
location and advised that if anyone was found on the property that she wanted to press charges on behalf of Main Street Renewal. Kimberly advised that
on November 27th of 2023 the occupants were served with an eviction, and it was returned December 11th that all occupants exited the property.
Officers and | went back out to the residence and set up a perimeter. | found that the back slider wood was ripped off and you could smell cigarette smoke
coming from inside the house. | made foud commands for anyone who is the house to exit and come out. Later a white male named Ryan Whidden exited
the back slider and was detained. Ryan was brought to the front of the residence and interviewed by Officer Martin.
Asearch of the property was conducted, and no other persons were found inside.
Ryan advised post Miranda that he came back to the residence on January 3rd and ripped off the wood sheet that was covering the slider and has been
there since then. Ryan advised that he had a verbal agreement with a friend named John Nelson that he could stay there, Ryan advised he has been staying
there for around 1 year.
Ryan was placed under arrest and transported to the PD for booking. Ryan was later turned over to the Brevard County Jail. He was charged with burglary
and criminal mischief. He entered a residence where he was not authorized to enter and additionally, he damaged the residence. Approximate cost to fix
the damage is $200.00 in parts in labor.
Sthcerof Complagant’s Sanature ioe [Gificers/Complainants Name [orintedy
Digitally signed by Isaac Dean
isaac Dean Date: 2024.94.04 16:08:22 -05'00° 280 Ofc. 1, Dean 1D#280
Filing.189138324. 05-2024-CF-010390-AXXX-BC.
ae
AGENCY NAME:
a CITY OF PALM BAY POLICE DEPARTMENT
ee . BREVARD COUNTY, FLORIDA, ‘Arresting Agency Cave Number
i
VICTIM INFORMATION PAGE
Fondant /luvenile Name last, First, Middle) [Oats Number
Whidden, Ryan, John
-
Vietim was natified of their Ma 's Lawrights~ Yes NO Victim requests their personal information remain confidential - Yes nO
victim Type Business individual Name (Last, First, Middle) or Business Name Victim's Relationship to Offender
individual | Mainstreet Renewal Relationship Unknown
Victim Address [Business Pointof Contact Name andNurber
© | 620 Malabar Rd. SE, Palm Bay, FL 32907
(Contact Number
/ Type (include area code) ~TWictinn’s Erna Address
321-473-0160
a i a
Victim was notified of their Marsy’s
Law ‘ights YES. NO Victim requests their personal information remain confidential = Yes NO.
icin ype Business individual Name (Last, First, Middle) ar Business Name [istin's Relationship to Offender
individuat |
Victim Address [dusiness Point of Contact Name and Number
(Contact Number / Type (include area code} \Vietim's Email Address.
ene —
[Victim was notified of their Marsy's Law rights - YES NO Victie requests their personal information remain confidential YES NO.
Victim Type _ Business individual Name (Last, First, Middle)or Business Name \Wictim’s Relationship to OHfender
~ _ Individual
Victim Address [easiness Point of Contact Neme and Number
[Contact Number / Type {include area code} |Victimn’s Email Address
~
Victien was notified of their Marsy's Law rights ves NO Victim requests their personal informati n remain confidential - YES
Victim Type Business individual Name (Last, First, Middie) or Business Name Victim's Relationship to Offender
_ Individuat
Victim Address [Business Point of Contact Name and Number
e / [Contact Number
/ Type lindude area code} Victim's Email Address.
oe sa a
Victim was notified of their Marsy's Law rights YES NO. Victim requests their personal information remain confidential - ~ ves nO
Victim Type — Business: individual Name (Last, First, Middle) or Business Name \Victim’s Relationship to Offender
_ Individual {
I
Victim Address [Business Pointof Contact Name and Number
[Contact Number / Type (include area code) \Wictirn's Email Address
see
Victim was notified of their Marsy’s Law rights ves NO. Victim requests their personal information remain confidential ~ ves NO
Victim Type ae Business. Tindividual Name (Last, First, Middle) or Business Name "[Wietim’s Relationship to Offender
_ individual
Wictim Address [Business Point of Contact Name and Number
i ~
“>| Contact Number / Type {include area code) 's Email Address
i
t
[Ofcer'Sj Complainants Signature ioe Stiice’ s/Complainant's Narwe (Printed)
Digitally signed by isaac Dean
Isaac Dean Date 2024.01.04 16:10:15 -05'00° 280 Ofe. 1, Dean 1D#280
a a lo
Filing 189138324 VS 05-2024-CF-010306RxSX'BE- |
Preview
Filing # 189138324 E-Filed 01/04/2024 08:15:58 PM a ay FORM | On View PC Arrest) x PURPOSE Capias Request rh ¥E5 ae nox | PROBABLE CAUSE AFFIDAVIT a Taken nto Custody (Warean/Capias Arrest) Summoned (Cited (NTA Referral ivi Citation [arresting Agency O8i Number Tarrenting Agency Name Rvesting Rgercy Cova) Rivest Namibee JORTE Number 051200 | CITY OF PALM BAY POLICE DEPARTMENT __PS0)- | Booking Agency6 ORI Yes) 24-000102 FOUE Namber anspor iat Dateline - . FB Nomber BOC Rumber Tene [ail Booking Nomber Location of Arvest (include Name of Susiness) oy VY@Y/2-3 1909 2Y-co009/: Seation of Offense finclade Narve af Business ~ ay a : cS 1156 Alpine Ave NW City of Palm Bay 1156 Alpine Ave NW City of Palm Bay Bieri ie BR ie Hanae reer (Charge Type elect ss mary as apply) Felony [Evidence Contiscated (Select as many ax anni) 01/04/2024 61/04/2024 14:47 Misdemeancr trate Ordinance Vehicle Fieeneem Property sn a a Name (Last, First, Middle) Bike and Type Bacot anh ee acket Worber Whidden, Ryan, John 07/31/1988 35 SPPF VS Jisce inci ee Height ie Eye tier frais Color White N/A Male 59 150 Ibs Biue Black Sears, Marks, Tattoos, Unique Physical Features (location, Type, Besciiplon) . None (ocal Address treet, Apt. Numbers Homeless Git. State, ip aa TA aa rimacy tangas Enatsh OC N/A bee Permanent Address (Siveet, Ant. Numbeil or parents huvenile ~ — Gay State, Bp Phone/iype linclade area cade) [Complexion 3 : (Same as Address) Light Bosiness Address (Street, Apt Number) Gy, Sate, Zin riage Tsk we eae aid Stim Briers \icense Stata/ Nomber/ Type Social Security Number ins Naber Place af inh a enna FL/W350730882710/E United States of America Residence type. iaark Ai that Apply W, N, Get) Sespect of Using (¥,N Unk) Drugs N ity DE County Florida Outot State Homeless ¥ Sex offender ® Gang Affiliation W Alcona N Computer? Handheld Device PARENT Driver's License State / Number? Type [PARENT Social Security Number™ [iivenile Gril tation hot Relevved Explanation Tivenile Fachiny “a * Collection of social security numbers from an arrested indvidual isto veily identi dnd may be shared with other fae enforcement agencies. Pe caps Warrant ‘Additional Charge Date issued onyajz024 Wet Aft ‘Bamestic Vislenen me Grdes of Arrest Charge Gescrtpion Couns 5 Statute) Ordinance Nomber ie ciasaier Burglary a ona 310.02(3}(b) Srug hetty [Bren Fyee Amounifint Baad Amount (Warrant / Chation / Court Number 5 $2000 - “The tindersigned certifies and swears that he/ahe has just aed reasonable grounds to believe and does believe and does believe that the above ‘Gefendant committed the folowing wolation afiaw Jonthe 4th day of rer a eer — AM xem ‘Speciicaiy incude fects constituting cause for arvast) Ee See attached narrative. ie - Th accordance with € SS, 958 27, 1 hereby request “aimbursamont al ivestiguiive costs Consisting of iOS “perbr and/or ‘les@ ermine ora total ofS Affidavit Artached:. wes OC no ~ a a Continue for Narative XX chanees XX Vacation oor Room Namie, Adare) Baare Mandatory Appearance Viera Court House, 2825 judge Fran Jamieson Way, Viera, Fi 32940 in Court ate fone Ser Yeon ee . AGREE YO APPEAR AT THE TIME AND PLACE DESIGNATED TO.ANSWER THE OFFENSE CHARGED OR 10 PAY THE FINE SUBSCRIBED, | UNDERSTAND THAY SHOULD 1 WILLFUILY FAIL TO APPEAR BEFORE THE COURFAS REQUIRED = a 8Y THIS NOTIVE TO APPEAR, THAT | MAY BE HELD IN CONTEMPT OF COURT AND A WARRANT FOR MY ARREST OR A TAKE INTO CUSTOOY ORDER SHAK BE ISSUED. H Signatute of Gelendant / uvenile Signature of iuveniie’s Parent / Custodian Reivase to (Name) Gate Time a hana a Noid for Other Agency [Werited 8 [Bo Not Bond Gut Remon Name: old for tst Appearance (Adults Ory) — Swear(allirm the ubove and attached statements ave| Ofluers/ G lainant's Signature Digitally signed by Iszae Sean ioe Toiticer ‘leamagan ame Print ied yueand correct 1DO on a gyaq isaac Dean ate: 2024.01.04 16:02-16-05'00 | 280 an la |Ofc. t. Dean 1D#280 Swoin and ssbseribed belare me, the undersigned [Notary Signature Ristary Newwe Printed} arg Caw Enc Bie i Retarance puthavity his cl oa teneiv trou 7 Dts = " January Sergeant P. Farmer 10#215 Filing 189138324 VS 05-2024-CF-010390-ARR-BE a AGENCY NAME: CITY OF PALM BAY POLICE DEPARTMENT — BREVARD COUNTY, FLORIDA, ‘Arresting Agency Case Number2 Continuation Page 2 Befendant/ vende Name (a, Fst Made) (OBTS Nomber Whidden, Ryan, john aoe a [Gor Deterdan name fast, Fst, Middle} Race Sox Date of Birth or Age ioveniie TN) Not Applicable oe Arcasted a artarge Chee | Felony Tica So-Betendant nate Was Fst Maa) fiace Sew Bate of Binh or Age haven 7) Not Applicable — ‘crested Ablange ites Felony Miademeanor ee ‘aia Warrent asin arae ‘re haved Re “Tea Chaige Descrpion oan OM | wont Statute? Ordinance Namber voleoce aren ine ciassfior Criminal Mischief a i ont 806.13{2) rag Acting [Sse Tree [Amouat/Unie Bana aaa (Warrant / Citation / Coun Namber $500 Caaias Wawra posters age te ase wean ‘Saree Vilanoe arrest charge Besertpion (counts * [Siatatey Ordinance Number Re classifier De. rag Ackiity Drop Type amount hint Bond Amount ~~ TWarrant/ Citation / Count Number ae cans warn ‘Adasen Charge I Date issued weit at Se wees, [Charge Bescrnpion Geant 5, Staite] Ordinance Nusiber ie casster ontae Brag Retvity Bie Fee famourefanit ‘Band Amount Warrant / Etation / Court Number a Fear make Model vn ag 7 Tag Siawe Primary Color [Secondary Color *if Applicabie, provide information related to the vehicle invelved in the crime. (Officer sf Complainants Signature Digitally signed by Isaac Dean Tow [Officer s/amplainant's Name (printed) Isaac Dean Date: 2024.01.04 16:04:26 -05'00" 1280 Ofc. 1, Dean 1D#280 05-2024-CF-010390-AXXX-BC.... AGENCY NAME: CITY OF PALM BAY POLICE DEPARTMENT BREVARD cbunt, FLORIDA Agency Case Number ene Ot NARRATIVE: Continuation Page 3 of 4 Defendant /laverile Name fast, Firs, Masdie} a BTS Hamnber Whidden, Ryan, John Caoiee wn ‘nessiona! uae [permed wena fe oa eleroe [Change Deseritpion reunes FS. [Statute] Ordinance Namber ie classter or Brag Atty Baie Tree Rrvourafonit ms ‘Amour Warrant] Chation) Gouct Number me z‘aeiae ‘warart aaniene Chege [ame ‘we a IE weience ‘aE res et Charge Descrnpion Counts (Siatute/ Ordinance Namber Re cassie ona Brag Retivty aig Troe famouneann Bond Amount [Warrant 7 Gtation / Court Number ‘canae arene ‘aitione: Cheers [ese wae area aaron Vance charge Descripion Coats rs Statute) Ordinance Namber Re-classifir Brug Activity Diag Wee fAmount/ini Bond Amount (Warrant 7 Gtation / Court Number ane On January 4th 2024, at approximately 1430 hours, | responded to 1156 Alpine Ave NW. On 1-3-24 | went out to the residence for potential squatters. We located a smashed out back slider and signs of people squatters. The property management Kimberly Lewis sent out a worker and had the back slider boarded up. Kimberley called today and advised that their staff just went out to the residence and there is a person at the house again, Kimberly resounded to the location and advised that if anyone was found on the property that she wanted to press charges on behalf of Main Street Renewal. Kimberly advised that on November 27th of 2023 the occupants were served with an eviction, and it was returned December 11th that all occupants exited the property. Officers and | went back out to the residence and set up a perimeter. | found that the back slider wood was ripped off and you could smell cigarette smoke coming from inside the house. | made foud commands for anyone who is the house to exit and come out. Later a white male named Ryan Whidden exited the back slider and was detained. Ryan was brought to the front of the residence and interviewed by Officer Martin. Asearch of the property was conducted, and no other persons were found inside. Ryan advised post Miranda that he came back to the residence on January 3rd and ripped off the wood sheet that was covering the slider and has been there since then. Ryan advised that he had a verbal agreement with a friend named John Nelson that he could stay there, Ryan advised he has been staying there for around 1 year. Ryan was placed under arrest and transported to the PD for booking. Ryan was later turned over to the Brevard County Jail. He was charged with burglary and criminal mischief. He entered a residence where he was not authorized to enter and additionally, he damaged the residence. Approximate cost to fix the damage is $200.00 in parts in labor. Sthcerof Complagant’s Sanature ioe [Gificers/Complainants Name [orintedy Digitally signed by Isaac Dean isaac Dean Date: 2024.94.04 16:08:22 -05'00° 280 Ofc. 1, Dean 1D#280 Filing.189138324. 05-2024-CF-010390-AXXX-BC. ae AGENCY NAME: a CITY OF PALM BAY POLICE DEPARTMENT ee . BREVARD COUNTY, FLORIDA, ‘Arresting Agency Cave Number i VICTIM INFORMATION PAGE Fondant /luvenile Name last, First, Middle) [Oats Number Whidden, Ryan, John - Vietim was natified of their Ma 's Lawrights~ Yes NO Victim requests their personal information remain confidential - Yes nO victim Type Business individual Name (Last, First, Middle) or Business Name Victim's Relationship to Offender individual | Mainstreet Renewal Relationship Unknown Victim Address [Business Pointof Contact Name andNurber © | 620 Malabar Rd. SE, Palm Bay, FL 32907 (Contact Number / Type (include area code) ~TWictinn’s Erna Address 321-473-0160 a i a Victim was notified of their Marsy’s Law ‘ights YES. NO Victim requests their personal information remain confidential = Yes NO. icin ype Business individual Name (Last, First, Middle) ar Business Name [istin's Relationship to Offender individuat | Victim Address [dusiness Point of Contact Name and Number (Contact Number / Type (include area code} \Vietim's Email Address. ene — [Victim was notified of their Marsy's Law rights - YES NO Victie requests their personal information remain confidential YES NO. Victim Type _ Business individual Name (Last, First, Middle)or Business Name \Wictim’s Relationship to OHfender ~ _ Individual Victim Address [easiness Point of Contact Neme and Number [Contact Number / Type {include area code} |Victimn’s Email Address ~ Victien was notified of their Marsy's Law rights ves NO Victim requests their personal informati n remain confidential - YES Victim Type Business individual Name (Last, First, Middie) or Business Name Victim's Relationship to Offender _ Individuat Victim Address [Business Point of Contact Name and Number e / [Contact Number / Type lindude area code} Victim's Email Address. oe sa a Victim was notified of their Marsy's Law rights YES NO. Victim requests their personal information remain confidential - ~ ves nO Victim Type — Business: individual Name (Last, First, Middle) or Business Name \Victim’s Relationship to Offender _ Individual { I Victim Address [Business Pointof Contact Name and Number [Contact Number / Type (include area code) \Wictirn's Email Address see Victim was notified of their Marsy’s Law rights ves NO. Victim requests their personal information remain confidential ~ ves NO Victim Type ae Business. Tindividual Name (Last, First, Middle) or Business Name "[Wietim’s Relationship to Offender _ individual Wictim Address [Business Point of Contact Name and Number i ~ “>| Contact Number / Type {include area code) 's Email Address i t [Ofcer'Sj Complainants Signature ioe Stiice’ s/Complainant's Narwe (Printed) Digitally signed by isaac Dean Isaac Dean Date 2024.01.04 16:10:15 -05'00° 280 Ofe. 1, Dean 1D#280 a a lo Filing 189138324 VS 05-2024-CF-010306RxSX'BE- |