Agency/Facility Information

Date Received: 9/21/2018

Date Uploaded: 9/21/2018

Date of Report: 9/21/2018 Amended Date:

Version Type: ORIGINAL

Arlington Police
Name of Agency/Facility: Street Address: 620 W. Division St.
Dept.

City: Arlington Zip Code: 76011

Agency Phone Number: (817) 804-2782 Director Salutation: Chief

Director First Name: Will Director Middle Name:

Director Last Name: Johnson

Name of Person Filling Stephen Email of Person Filling

steve.winchester@arlingtontx.gov
Out Form: Winchester Out Form:

Injured or Deceased Information

1. What was the injured or

Male
deceased's gender?:

2. What was the injured or

deceased's age at time of 24
incident?:

3. What was the injured or

Black or African
deceased's race/ethnicity?
American
(Mark only one):

Incident Details

Peace Officer Involved Injuries or Death Report :: Page 1 of 2

 4. Date of Incident: 9/1/2018 1:55 PM

5. Location of Incident

2400 block
Street Address: City: Arlington
California Lane

State: TX County: Tarrant

Zip: 76015

6. Incident Resulted In: Death

Carried, exhibited,
7. Injured or Deceased
or used a deadly
Person::
weapon

Peace Officer Information

PLEASE CLICK THE ADD PEACE OFFICER BUTTON TO ENTER INFORMATION ABOUT EACH PEACE
OFFICER INVOLVED.

Peace Officer's Gender Peace Officer's Age Peace Officer's Race/Ethnicity Peace Officer On Duty?
Male 35 Asian or Pacific Islander On Duty

Response/Incident Result Information

12. Peace Officer was

responding to call or request Yes
with one or more officers::

13. Incident occurred during or

as a result of a (hold down
Traffic Stop
CTRL on your keyboard to
select more than one value)::

Peace Officer Involved Injuries or Death Report :: Page 2 of 2