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DUAL ARREST
ALABAMA UNIFORM ARREST REPORT Yes Yes
No No
OFFICER'S WORK PRODUCT MAY NOT BE PUBLIC INFORMATION
1 ORI # 2 Agency Name 3 Case # 4 SFX
Henry Class
************* FL
25 FBI # 27 Identification Comments
NCIC Class
27 28 Home Address (Street, City, State, Zip) 29 Residence Phone 30 Occupation (Be Specific)
Resident
Non-Resident ******************************************************* ********** *******
31 Employer (Name of Company/School) 32 Business Address (Street, City, State, Zip) 33 Business Phone
13A-11-10
57 Charge - 3 58 UCR Code 59 Charge - 4 60 UCR Code
Fel Misd Fel Misd
61 State Code/Local Ordinance 62 Warrant # 63 Date Issued 64 State Code/Local Ordinance 65 Warrant # 66 Date Issued
67 Arrest Disposition 68 If Out On Release What Type? 69 Arrested with (1) Accomplice (Full Name)
Held Tot-LE
Bail Other 70 Arrested with (2) Accomplice (Full Name)
Released
Bottom
83 Juvenile 84 Released To
Handled and Released Ref. to Welfare Agency Ref. to Adult Court
JUVENILE
Dispostion:
Ref. to Juvenile Court Ref. to Other Police Agency
85 Parent or Guardian (Last, First, Middle, Name) 86 Address (Street, City, State, Zip) 87 Phone
99 Personal Property Released to Arrestee 100 Property Not Released/Held At: 101 Property #
RELEASED
Yes No Partial
103 Signature of Receiving Officer 104 Signature of Releasing Officer Local Use State Use
NA
MULTIPLE 105 Case # 106 SFX 107 Case # 108 SFX 109 Case # 110 SFX MULTI CASES/CLOSED
111 CONTINUATION
CASES
CLOSED Yes No
112 Arresting Officer (Last, First, M.) 113 ID # 114 Assisting Officer (Last, First, M.) 115 ID # 116 Supervisor 117 Watch Cmdr.
Cpl Gregory Kloepper 6655 Ofc Jason W. Goodwin 8483 Sgt Robin Rich ID # 4421 Lt Matthew Coffey ID # 4737
TYPE OR PRINT IN BLACK INK ONLY ACJIC -06-06