GA Incident 4Form.xft

CARTERSVILLE POLICE DEPARTMENT
SA
GA0080100
INCIDENT REPORT
INCIDENT TYPE
INCIDENT CODE
1
7399
EVENT
INCIDENT LOCATION (STREET #, STREET NAME, APT. #)
ROWLAND SP RD
INCIDENT DATE
TIME
CARTERSVILLE
DATE
TO
0318
09/26/2014
ZIP CODE
CITY
ZONE LOCATION CODE
30121
0346
09/26/2014
PREMISE TYPE
YES
COMPLAINANT LAST NAME
FIRST NAME
MIDDLE NAME
HUBERTY
S
J
FIRST NAME
MIDDLE NAME
1 - HIGHWAY
2 - SERVICE STATION
3 - CONVENIENCE STORE
4 - BANK
5 - COMMERCIAL
6 - RESIDENCE
7 - SCHOOL/CAMPUS
8 - ALL OTHER
1
WEAPON TYPE
STRANGER TO STRANGER
TIME
UNKNOWN
NO
COMPLAINANT ADDRESS NO., STREET
1 - GUN
2 - KNIFE/CUTTING TOOL
3 - HANDS/FISTS
OTHER
CITY
PO BOX 1390
STATE
CARTERSVILLE
VICTIM
RACE
SEX
ADDRESS NO., STREET
CITY
STATE
SSN:
ZIP
YES
NO
BUSINESS PHONE
CENSUS TRACT
EMPLOYER OR OCCUPATION
IF YES, NAME VICTIMS SCHOOL
ROBERTS
WANTED
OFFENDER
___-__-____
RESIDENCE PHONE
___-__-____
OFFENDER LAST NAME, FIRST NAME, MIDDLE NAME
WILLIS
CITY
ROWLING SPRGS RD
STATE
SEX
W
M
CARTERSVILLE
ZIP
DATE OF BIRTH
CENSUS TRACT
HEIGHT
504
HAI R COLOR
EYES
170
BRO
BRO
7399
1
___-__-____
WEIGHT
OFFENSE / ARREST JURISDICTION CODES
COUNTS OFFENSE CODE
CRIMINAL ATTEMPT BURGLARY
SSN
AGE
34
GA 30120
CHARGES
WARRANT
RACE
CLAUDE
ADDRESS NO., STREET
1
1. CITY
2. COUNTY
3. STATE
4. OUT OF STATE
5. UNKNOWN
1
ARREST
TOTAL NUMBER ARRESTED
ARREST AT OR NEAR OFFENSE SCENE
01
VEHICLE
PHONE NUMBER
STATE OF GEORGIA
STUDENT?
YES
TAG NUMBER
STOLEN
RECOVERED
YEAR
MAKE
STATE
MODEL
DATE OF OFFENSE
NO
09/26/2014
YEAR
STYLE
COLOR
MOTOR SIZE (CID)
WITNESS LAST NAME
FIRST NAME
MIDDLE NAME
C
J
ADDRESS NO., STREET
___-__-____
CURRENCY, NOTES. ETC
VEHICLES
MAN.
INSURED BY
SPD.
CITY
PO BOX 1390
SSN:
WITNESS 1 - DOB / Age:
VIN PLATE
ONLY
TRANSMISSION
AUTO
LAFRANCE
PLATE
ONLY
V.l.N.
SUSPECTS
WITNESS
AGE
DATE OF BIRTH
ZIP
GA 30120
SSN:
COMPLAINANT:
VICTIM LAST NAME
20144268
BURGLARY
OFFENSE:
COUNTS
CRIMINAL ATTEMPT BURGLARY
500
CASE NUMBER:
STATE
CARTERSVILLE
SSN:
WITNESS 2 - DOB / Age:
JEWELRY, PREC. METALS
FURS
ZIP
PHONE NUMBER
GA 30120 770 382-2526
___-__-____
PROPERTY RECOVERY INFO ONLY
PROPERTY
STOLEN
OFFICE EQUIPMENT
CLOTHING
TV, RADIO, ETC.
HOUSEHOLD
STOLEN
DATE OF THEFT
RECOVERED
CONSUMABLE GOODS
FIREARMS
LIVESTOCK
TOTALS
OTHER
STOLEN
0
0
CLEAR
DRUG
ADM.
RECOVERED
NARRATIVE
JURISDICTION
CODES
1. CITY
2. COUNTY
3. STATE
4. OUT OF
STATE
5. UNKNOWN
THEFT/RECOVERY
RECOVERED
GCIC ENTRY
WARRANT
MISSING PERSONS
DID INVESTIGATION INDICATE THAT THIS INCIDENT WAS DRUG-RELATED?
IF YES, PLEASE INDICATE THE TYPE OF DRUG(S) USED BY
VEHICLE
ARTICLE
YES
BOAT
GUN
SECURITIES
NO
1 - A M P H E T A M IN E
2 - B A R B IT U R A T E
3 - C O C A IN E
4 - H A LL U C IN O G E N
5 - H E R O IN
6 - M A R IJ U A N A
7 - M E TH A M PH ET A M IN E
8 - O P IU M
9 - S Y N T H E T IC N A R C O T I C
U - UNK NOW N
REQUIRED DATA FIELDS
FOR CLEARANCE REPORT
CLEARED BY ARREST
EXCEPTIONALLY CLEARED
ADULT
JUVENILE
UNFOUNDED
REPORT DATE
DATE OF CLEARANCE
09/26/2014
REPORTING OFFICER
NUMBER
APPROVING OFFICER
NUMBER
HUBERTY, S.J.
64
HUBERTY, S.J.
64
09/26/2014
Page
1
Page
of
4
1. Original
Juvenile
2. Supplement
in Report
Agency Report Number
PERSON(S) REPORT
N
SUSPECT OR MISSING PERSONS
SUSPECT OR MISSING PERSONS
VICTIM / WITNESS
VICTIM / WITNESS
CODES
ADM
Date of Supplement
CARTERSVILLE POLICE DEPARTMENT
Original Date Reported
Primary Offense Description
09/26/2014
BURGLARY
Injury Type
00. N/A
01. Gunshot
02. Stabbed
V/W Code
OFF/INC Indicator
1.#1
2.#2 3.Both
#
V. Type
MISSING PERSON / RUNAWAY
Sex
N-N/A
M-Male
F-Female
U-Unknown
I-American Indian
O-Oriental/Asian
U-Unknown
Residence Status
0. N/A
1. Full Year
2. Part Year
3. Non-Resident
Residence Type
3. Georgia
0. N/A
4. Out-of-State
1. City
2. County
Extent of Injury
0. None
1. Minor
2. Serious
3. Fatal
Victim Relationship To Offender
1. Present Spouse
2. Former Spouse
0. N/A
3. Parent
4. Child
5. Step Parent
6. Step Child
7. Foster Parent
8. Foster Child
9. None of the Above
Name (Last, First, Middle or Business)
Residence Phone
1
City
Address (Street, Apt. Number)
State
Zip
Business Phone
Social Security Number
___-__-____
Other Contact Info. (Time Available, Interpreter, etc.)
Dom. Violence
If V/W Code is
V, W or C
Fill in this Line
V/W Code #
OFF/INC Indicator
1.#1 3.Both
2.#2
Address (Street, Apt. Number)
Race
Synopsis of Involvement
Date of Birth
Sex
Res. Type
Age
Res. Status
Extent of Injury
Injury Type(s)
Relationship Ethnicity
Will Victim prefer charge?
Yes
V. Type
No
Residence Phone
Name (Last, First, Middle or Business)
City
State
Zip
Business Phone
Social Security Number
___-__-____
Other Contact Info. (Time Available, Interpreter, etc.)
Synopsis of Involvement
Dom. Violence
Res. Type
Res. Status
Date of Birth
Age
Race
Sex
If V/W Code is
V, W or C
Fill in this Line
Suspect Code
OFF/INC Indicator
Code Susp. # Juvenile Name (Last, First, Middle)
1.#1 3.Both
S-Suspect E-Escapee R-Rec. Missing
2.#2
A-Arrestee M-Missing Z-other
Maiden Name
Nickname/Street Name
Extent of Injury
Occupation
Employer/School
Driver's License State/Number
Immigration and Naturalization Number
Will Victim prefer charge?
Place of Birth
No
Residence Phone
Zip
State
Business Phone
Address
Social Security Number
SCIC/NCIC
OBTS Number
Other ID. Number
Scars/Marks/Tatoos (Location/Describe)
Sex
Date of Birth or Age
Build
Complexion
OFF/INC Indicator
1.#1 3.Both
2.#2
Maiden Name
Height
Facial Hair
Teeth
Suspect Code
S-Suspect E-Escapee R-Rec. Missing
A-Arrestee M-Missing Z-other
Speech/Voice
Code Susp. #
Juvenile
Weight
Hair Color
Eye Color
Hair Length
Hair Style
Special Identifiers
Name (Last, First, Middle)
Place of Birth
Nickname/Street Name
Last Known Address (Street, Apt. Number)
Employer/School
Driver's License State/Number
Immigration and Naturalization Number
Residence Phone
State
City
Occupation
Zip
Business Phone
Address
Social Security Number
Other ID. Number
Clothing (Describe)
Race
Relationship Ethnicity
Yes
Clothing (Describe)
Race
Injury Type(s)
City
Last Known Address (Street, Apt. Number)
OBTS Number
SCIC/NCIC
Scars/Marks/Tatoos (Location/Describe)
Sex
Complexion
Date of Birth
Facial Hair
Build
Teeth
7. Voluntary
Adult
8. Unknown
Time Last Seen
Fingerprints Available?
1. Yes
2. No
8. Unknown
Photo Available?
HUBERTY, S.J.
Officer Reviewing (If Applicable)
1. Yes
2. No
8. Unknown
MCIC Form Provided ?
1. Yes
2. No
ID. Type/Number
Transportation Mode
2. LocatedNot Returned
ID. Number(s)/Locator code
3. Hospitalized
4. HRS Custody
5. Law Enforcement Custody
6. Returned to Parent
Signature of Officer Reporting
7. Deceased
9. Other
Date
Unit
64
ID. Number
Hair Style
Doctor/Dentist (Name, Phone Number)
Name/Address
0. N/A
1. Voluntary
Dental Record Available ?
1. Yes
2. No
8. Unknown
Accompanied By
ID. Type/Number
Officer(s) Reporting
Signature of Officer Reviewing
Missing Before ?
Medication Required/Type
Probable Destination
Hair Length
Hair Color
Special Identifiers
1. Yes
2. No
8. Unknown
Location Last Seen (Address, City, St.)
Property Carried
Eye Color
Weight
1. Yes
2. No
Mental/Physical Condition
HUBERTY, S.J.
Speech/Voice
Foul Play Suspected ?
1. Runaway
4. Disabled
2. Parental
5. Endangered
3. Involuntary 6. Disaster Victim
Date Last Seen
Recovery Information
Height
Age
Incident Type
ADMINISTRATIVE
Race
N-N/A
W-White
B-Black
4. Business
5. Government
6. Church
9. Other
07. Loss of Teeth
08. Burns
09. Abrasions/Bruises
99. Other
03. Laceration
04. Unconscious
05. Poss. Broken Bones
06. Poss. Internal Injury
20144268
Victim #1 Name (Last, First, Middle)
STATE OF GEORGIA
Victim Type
0. N/A
1. Juvenile
2. L.E. Officer
3. Adult
V/W Code
O - Other
V - Victim
W - Witness
C - Reporting Person
1
UNIF
Routed To
Referred To
Assigned To
By
09/26/2014
Date
64
Page
2
Page
of
4
PROPERTY REPORT
ADM
Date of Supplement
Original Date Reported
Primary Offense Description
BURGLARY
THEFT
CODES
PROPERTY
STATE OF GEORGIA
Theft Type
02. Robbery
03. Shoplifting
Person Codes
V - Victim
S - Suspect
04. Pocket Picking
05. Purse Snatching
Status Codes
1. Stolen
2. Recovered
A - Arrestee
O - Other
Property Type
A. Auto Accessory/Parts
B. Bicycle
C. Camera/Photo Equipment
D. Drug
Code
Person
Item #
Status
PROPERTY
PROPERTY
Quantity
09. From Vehicle
10. Extortion
7. Safekeeping
8. Evidence/Seized
9. Other
O. Office Equipment
P. Art/Collection
Q. Computer Equipment
R. Radio/Stereo
S. Sports Equipment
J. Jewelry/Precious Metal
K. Clothing/Fur
L. Livestock
M. Musical Instrument
N. Construction Machinery
Property Type
Value
11. By Computer
12. Fraud
99. Other
Damage Codes
0. N/A
2. Criminal Mischief
1. Arson
3. During other Offense
T. TV/Video/VCR
U. Currency/Negotiable
V. Credit Card/Non-Negotiable
W. Boat Motor
X. Structure
Name
01
Brand
9. Other
Y. Farm Equipment
Z. Miscellaneous
Model Name/Number
Description (Size, Color, Caliber, Barrel Length, Etc. )
Value Recovered
Date Recovered
SCIC/NCIC
$
Person
Item #
Status
Damage
Serial Number
Property Type
Quantity
Name
Brand
Model Name/Number
Description (Size, Color, Caliber, Barrel Length, Etc. )
Owner Applied Number
Value
Value Recovered
Date Recovered
SCIC/NCIC
$
Code
Person
Item #
Status
Property Type
Damage
Serial Number
Quantity
Name
Brand
Value
Model Name/Number
Description (Size, Color, Caliber, Barrel Length, Etc. )
Owner Applied Number
Value Recovered
$
Date Recovered
SCIC/NCIC
$
Code
PROPERTY
5. Lost
6. Found
Owner Applied Number
$
Person
Item #
Status
Property Type
Damage
Serial Number
Quantity
Name
Brand
Value
Model Name/Number
Description (Size, Color, Caliber, Barrel Length, Etc. )
Owner Applied Number
Value Recovered
$
Date Recovered
SCIC/NCIC
$
Code
PROPERTY
08. From Public
Access Building
3. Stolen and Recovered
4. Recovered for Other Jurisdiction
Damage
Serial Number
Code
Person
Item #
Status
Property Type
Damage
Serial Number
Quantity
Name
Brand
Value
Value Recovered
Date Recovered
SCIC/NCIC
$
Property
Stolen
$
Change in Property
Stolen Value
$
Property
Recovered
$
Change in Property
Recovered Value
$
Activity
P. Possess
S. Sell
B. Buy
T. Traffic
Model Name/Number
Description (Size, Color, Caliber, Barrel Length, Etc. )
Owner Applied Number
$
TOTALS
06. Embezzlement
07. From Coin Oper. Machine
E. Equipment/Tool.
F. Food/Liquor/Consumable
G. Gun
H. Household Appliance/Goods
I. Plant/Citrus
$
CODES
20144268
Victim #1 Name (Last, First, Middle)
Theft Type Codes
00. N/A
01. Burglary
1
Agency Report Number
CARTERSVILLE POLICE DEPARTMENT
09/26/2014
R. Smuggle
D. Deliver
E. Use
K. Dispense/Distribute
M. Manufacture/Produce/Cultivate
Z. Other
Type
A. Amphetamine
B. Barbiturate
C. Cocaine
E. Heroin
H. Hallucinogen
M. Marijuana
O. Opium/Derivative
P. Paraphernalia/Equipment
S. Synthetic
U. Unknown
Z. Other
Unit
1. Gram
2. Milligram
3. Kilogram
4. Ounce
5. Pound
6. Ton
7. Liter
8. Milliliter
Activity
Type
Description
Quantity
Unit
Estimated Street Value
$
Activity
Type
Description
Quantity
Unit
Estimated Street Value
$
Activity
Type
Description
Quantity
Unit
Estimated Street Value
$
9. Dose Unit/Item
ADMINISTRATIVE
PROP. DETAIL / NARR.
DRUGS
1. Original
2. Supplement
Officer(s) Reporting
ID. Number(s)/Locator Code
HUBERTY, S.J.
64
Officer Reviewing (if applicable)
HUBERTY, S.J.
Signature of Officer Reviewing
ID. Number
Signature of Officer Reporting
Unit
UNIF
Routed To
Referred To
Assigned To
By
Date
09/26/2014
Date
64
Page
3
Page
of
4
NARRATIVE CONTINUATION
ADM
Date of Supplement
1. Offense
2. Arrest
2
Juvenile
Warn/Dismiss
Agency ORI Number
CARTERSVILLE POLICE DEPARTMENT
GA0080100
Original Date Reported
1. Original
2. Supplement
1
Agency Report Number
20144268
Case Reference
09/26/2014
BURGLARY
NARRATIVE
On Friday, September 26, 2014, at approximately 0315 hours, I was patrolling the area of
Market Square, near M L King Jr., Drive and J F Harris Parkway. At this time, I saw a black female
who I was familiar with waving her hands (Witness 1). Witness 1 state she thought there was a man
trying to break into the old Long John Silver place (500 Rowling Springs Rd). I advised Bartow 911
of the information and started towards the building.
As I was at the traffic light on M L King Jr., Drive, waiting to cross over J F Harris, I
could see a male subject dressed in a hat, shorts and sneakers with no shirt on attempting to
force the window of the driver through lane. I watched as the suspect (later identified as Willis
Claude Roberts Jr) continued to attempt to force the window by placing his hands on the glass pane
and trying to break it by bouncing his weight against it. Mr. Roberts then appeared to wrap his
black shirt around his hands and then he went back to trying to force the window. As I crossed
over J F Harris Parkway, Mr. Roberts put his shirt back on and stood by the window.
I made contact with Mr. Roberts. I asked him to come down and sit on the curb. Mr. Roberts
walked to me and sat down. I asked what he was doing and he replied, nothing. I asked why he was
trying to break in to the building and Mr. Roberts stated he was not, he did not steal anything.
At this time, Officer LaFrance arrived and Mr. Roberts was taken into custody for Criminal Attempt
Burglary (OCGA 16-4-1).
Mr. Roberts was handcuffed, checked for fit and double locked. Mr. Roberts was placed into
the rear of a patrol car. During the handcuffing process, I found cuts to Mr. Roberts hands and
Officer LaFrance noticed a small amount of blood. Officer LaFrance confirmed the window had not
been broken earllier in the night.
Mr. Roberts was transported to the Cartersville Police Department by Officer LaFrance. Mr.
Roberts then began to refuse to cooperate with officers and began to kick the car cage and
spitting across the patrol car to the opposite window.
Mr. Roberts was then transported to the Bartow County jail where he fought the intake staff.
Pictures of the window were taken. Mr. Roberts would not cooperate to get pictures of his
hands.
The rear of both patrol cars were checked at the start of shift, prior to and after each transport
with no contraband found.
A warrant was secured for Criminalll Attempt (Burglary) 16-4-1.
No further.
ADMINISTRATIVE
Report Contains
Related Report Number(s)
Signature Officer Reporting
Unit
ID. Number(s)
64
Reviewing Officer Signature
Case Status
CA
Exception Type
Clearance Type
UNIF
3.Unfounded
4.Open Pend.
1. Extradition Declined
2. Arrest on Primary Offense or
Secondary Offense Without Prosecution
1
A - Adult
J - Juvenile
3. Death of Offender
4. V/W Refused to
Cooperate
Date Cleared
A
09/26/2014
Assigned To
Referred To
Routed To
1.Arrest
2.Exceptional
Date
09/26/2014
5. Prosecution Declined
6. Juvenile / No Custody
By
Arrest Number
Date
Number Arrested
200144266
OBTS Number
1
Page
4
Page
of
4

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