Transcript of 166-12c-1_serial_1_section_2_56-la-156_la_report_6.9.68-part_1_of_7.pdf
==================================================
Page 1
==================================================
LA 56-156
SECTION IT
Los Angeles Report 6/9/68
Pages 275-619
SIRHAN BISHARA SIRHAN
CIVIL RICHTS
==================================================
Page 2
==================================================
CA 56-156
JCA /kaf
ARREST CONFINEMENT AND
PROSECUTIVE ACTION CONCERNING
SIRHAN BISHARA SIRHAN
-275-
4
==================================================
Page 3
==================================================
LA 56-156
According to Los Angeles Police Department
Rec orda at 12:30 .a#m- On June_5 , Hor8ze
SIRHAN was arrested by Los Angeles
SBepartBes[ABficers
5 R WHITE (Number 13308 ) and ARTHUR PLACENCIA (Number 13742 )
at the Ambassador Hotel , 3400 Wilshire Boulevard
8
Los Angeles ,
California under the name of "JEFN: DOE #1" He was charged
with suspicion of 217 PC (assault with intent to murder
SIRHAN had no identification on his person &d refused to
reveal his identity_
According_ to Los 'PLAaE88e8 Police epaitaeztg
Records Officer ARTHUR read the
statement to SIRHAN you have the right to remain silent
If Jou give up the right to remain silent , anything you say
can and will be used against you in a court of law You
have the right to speak with an attorney and to have the attorney
present during questioning_ If yoi 80 desire and cannot
afford one_ an attorney Will be appointed for you without
M charge before questioning_ SIRHAN Was then asked Do you
"I unders tand your rights at which time he replied" Yes
fi Do you wish to remain silent ?" at which time he replied
:i Yes and Do you want an attorney present to which he
I[ lied Yes _ SIRHAN Ta8 booked as JOHN DOE #1" on June 5, 1988
at 2:20 a.m .
SIRHAN BISHARA SIRHAN was examined at 2:01 a ,m. ,
June 5, by Dr _ E.C LANZ at the Los Angeles Police
M Department under the name JOHN DOE Suspect" Medical
findings indicated a swelling of his left ankle, probable
spraing no fracture C ontusion of his left index finger ;
hematoma of forehead and minor abrasions of face
276
2"
2i1
1968
==================================================
Page 4
==================================================
LA 56-156
TLD :mak
On June 7 , 1968 , SA EDWARD A PLEVACK received
a photograph from Lieutenant C . F_ HUGHES Rampart Division ,
Los Angeles Police Department
9
which had been taken by
HAL BURBA of the Los Angeles Fire Department on June 5 , 1968_
This photograph depicts OwO individualg attempting to subdue
the suspect To the right rear, according to Lieutenant
HUGHES can be obs erved an individual whom he believes i8
ROOSEVELT a Los 'Angeles Rams football player
277
GRIER ,
==================================================
Page 5
==================================================
0
Sn
3'#
==================================================
Page 6
==================================================
LA 56-156
JCA/sro
Lieutenant C . F HUGHES Rampart Division, Los Angeles
Police Department
9
furnished SA EDWARD A PLEVACK a photograph
of suspec t SIRHAN BISHARA SIRHAN being held by a police officer
at the Ambassador Hotel
275
==================================================
Page 7
==================================================
==================================================
Page 8
==================================================
1
LA 156
TLD/agi
The following is a photograph Jf SIRHAN B SIRHAN
as he i8 being ren oved by Los Angeles Police_Department
(LAPD) Officers from the Ambassador Hotel_ The photograph
was made available by Lieutenant C . F HUGHES , Rampart
Division
9
LA PD _
281
56 .
==================================================
Page 9
==================================================
~383-
==================================================
Page 10
==================================================
CA 56-156
JCA /kaf
The following is a photograph of SIRHAN BISHARA
SIRHAN when he was booked by the Los Angeles Police
Department following his arrest for shooting Senator
ROBERT p KENNEDY :
283
==================================================
Page 11
==================================================
{
C6- 5 -68
LOS ANGELES
3
BK 495 139
==================================================
Page 12
==================================================
FD-3 02 (Rev. 4-15-64 )
FEDERAL BUREAU OF INVESTIGATION
6/8/68
Date
On June 7, 1968, Lt_ CHARLES HUGHES_ Los Angeles
Police Department , made available the atached records _
On
6/7/68
at
Los Angeles , California
File #
Los Angeles 56-156
285
SA EDWARD A PLEVACK/af 6/8/68
by 'Date dictated
This document contains neither recommendations nor conclusion8 of the FBI. It is the property of the FBI ad is loaned to
your agency; it and its contents are not to be distributed outside your agency_
==================================================
Page 13
==================================================
AnrEST ?eport
COMBAED CRIME AID AKREST REPE DR # LRSLliL!# LA #
@RT} ETvct S OCCWPATIOT VESCEMT, 7GE BcDkahg WUBffi Loc.ekd. WER'S LicENSE MumdER STATE EVID. #KO?
RE?GKT
205.127 Yes
TYFE QF PREFSES APreSTEe s RAEE {nst, Tirs!, #ddk; SEX DESCEmT NAHR
{Lez Tz
Ok lruv 2U
TYPE 0F OFFESE ZTES 3 899 TR@Fvsetz
Ass!zrUANTei To
murder
E1n 2$
IYrc Vi Pc?ERTY TotA_VAlie 047.3 TET;1RREST _ DATE <TIME RRRESTED TIE BOOKED
2_ lzarip 2948 JNL 6, 42_EzA| 2
Juv RESID. RD_ PAREMTS Notifico BY HIME TocTTori CF" ARREST RFT . DiS, PROB Inv_ UmIT
ONLY 34-0 UJLifle
S3LLRA DG7
FLACE JUV_ DETAIMED Civ. CF APPEARANCE DATE{TIME TpE Ci;RZE Rhn, C3cv368 Ceriaitio;) ASSTUCG Df-TfW;TTR VZRFir
Susp (c_
72 minde
BR2,. APPRUVED By DETEAT. APPROVEO 5Y TOCATION CRIZE CO;NTTTED RPT_ DIS. Toc; DIsPoSITIO; 0F ARRES;EE"S VEHICLE
PRNTEd? Y M
PhJTOS? Y N 34/0 11ezlz C Nose
BIRTHeiASE x}sale Sgcial SECURITY # OBSERYABLE PMYSTCAL ODDIT{ES, #ARKS-_Evid. MARC, USE OCCUPATion GRADE EMPLOYER/SCKOSL
reFu5ed refuseil
RZSTDE;ICE ACJRESS CiTY CLOTMING $owN
REESE)
8Lus4eRLLE4eXWAt&
[TCOMECTIRS RFTS. eY TYF'E & ICERTIFYTG MUREZRS CJ"RLARTS R 0ET77JK E: 8kz33 2QRE E
S04 = PAC: IXbex PQpF % Eur EEFogT_ ABqyi_T2+
CliL:Id DRI €. C 4E
YLiicieGst: %;er, %Wikc; bod) Styie, colors; {ic. #(in merks} DRIVNG VEH. #dinclion & nara 0! sl) At 0R BETVEEER S7REz7s
L7ee
CODE: yYictiM {ir NARE IF GUSINESS) W-WITNESS ON JUVENILES ONLY: P-BOTH NATURAL PARENTS 6 SWARDIAN
CIDE NAME ADORESS CIty PHCNE X
Ci7itz KENVEdy RoBert F +6o1
BUs _
RES_ Lresr,RoriGLELT
BUS_
RES_ JoleAL_RAFEr
3US.
RES_
BUS
ADOMITION TKE FOLILOWING ST'ATEMZNT' WAs READ TO "HE ARRESTZE: "Yol have the right tc rcirlin silent Ij 361
0} give #p the right to ~enain silent, anything Scy Ccn inzl wvill be used againsl yow in € court of law. You njv?
Rlonts tne right lo Speak Rith an attoruey and to have the ctforney present during questioning. If SO desire @nc cdnno:
2} afford one, @n attorney will be appoirted for uithout_charge before questioning-
TKIS ADMONITION WAS READ TQ THE ARRESTEE BY (Name &.Sgrial #}:
434le_
OF ARREST: 2 SCUFCE Jf ACTIvITY; 2. OBSERWATIOM; 3_ ARREST; 4 BCJKING_ SPECIFIC HEADINGS: 1 EVIDENCE (narzo ia 2jilc 41255}; EREEKETs NSEFIcRFos3R
2 {mJl:IzS; 3. ACRAVAIED CIR UMSTA"CES; 5_ ADOFTIONAL (rasn jnsik de aied, elc_):
OO Yol_ULDEESALLD_ Yovr Rleue:
22 You_ LlzH ~To ZiAle SILENIZ fes
:0o You LALII Nt4 #ICQKAg_ ZEE EACZ
Suspecr SHII SixVIarm$ ERITIE)ZNPeesese Of T7
WNeAPpRE4heD Sos?eCT Aklb PSARmeD i{m_ SsneCr Retuses
16 6iv? NAM €
additicza: spJ:e i; neide ' Lic Cinlizualian $x88, Form %3 9
hyite Tf F/3b0.
2iwR 2v"8 noU
#eavisR SERIAL 770, RZFoZTIR; 077ICER;z) SERIAL #o(s) . Ciision-EETATL VACTRJRSATETS:
{ICENUA O} t}!; /bn"-2 2mi2_X42
"44t
To BE COM?LETED 6Y INVESTIGATCR
COMMErTS OF ToestigatorIKC_UCT WrzXT REFTkRIO, Tia,iz Cf AGency Anin PERSon TccePTTSG KEFERRAL
2 732r3/EFCRT DiSPUS TictA3nRAis GS TI?fT TTpicui;on 'Jerennia ER fiic T;d)
Coun:' & Bel [J Fcver/adw!: Z-'nccen?
Acf n $? Exon i4 eviJ. Szig! 35242Y C{i 0oeendo"&iisnCy Otkcr
INYES)G;TIRG 0C_ SExiAL Ko. AzClt PZESE,T AT [NTERFTET SlPeR} SorA P3oMMG SERMAL #Q. DATETTIEE RePRop V3vTcizzk
286
2seh
5 7_104 Ja:c ARIST PeoRt
87317
4W
AnJ
RES_
W-
"You
you
Iou
Y02
(f UJ) +
74
Ev 1v'
==================================================
Page 14
==================================================
CRIBPE rEPORT -cJl
ecyx cbacl Eare
4 $ DR= 68-9213464
TEAFON, FoRcE 0R HLAMS USED (7,rike CJi U%: TYP_ (Rur-S7Jl , Eail,,tlc
sl_
2
KSRRERT MSTIVZ LocaT,o; QF OCCURRERCE KzPORTiNG Dist
/
7400
TO. OF SUSPECTS SLX DESCENT DRTE Tro TizE occiKKED DATE ANID TimE REPORTED Te P.o_
TRADEMAR:$
"8 hosreerg;
(Action; Pf contcrsl
Apror Zms & 1zz12 63-28
1L5Ap
Zhoz ~5 hKoyio Lass SAces
inVESjicATiVE DvisiaRis) }; U;itis) #OTIFIEO JHHD PERSUMS) Confa
vExic
8468
E USED BY
SugFECTE_Ync-Lody-colTic
6.XTD) Tist ATiY
co /recrki
RFTtS}. By TYPzARd D R Tio_ ZICTI'S_COND. (HED,
7EE
MORMAL, ETC )
Lzi Nerne l
CODE: V-Victix R-ERSON REpoRTing CMME W-WitNEsS 4LA
~ctin's OCCUPATiON SEX DEScE;it - DATE OF BiRTFi CODE RESIDET ADDRESS (Bus aaa" {f Tirm) iTY RES. PMONE X BLS . PHOME X
UeS_Saxers-EhCauc
Resiec (
@rezurs-Kocs?
2C
6.z-Ss2a_
Lziplz
Lo
TucmtiFY TUSPECT(S) BY Ro. TNaric-JCJress-Sex-deszcnt-agc-hl-#l-hafr-eyes-corilexicr-clomhin;-7zer 7fyin] characierislics. Tf arrcslad_ includc Bkg no _ & charse }
Johx_ {2vc2k_226si-3/Yf
ai-ibriitiny ADDiTiC VAL" SiS?ECT(S) _ (2) Reco,STRUCT THE cRime "DESCISE" TuVsicAt"
EazvuitZoaMI
TocArion FoUro , AND GVE DISPOSTTIONT. T4) SUMARIZE OTFER
DEtaiLS RelaTiNG To criie_ (5} TIXE And LocfTion WMERZ VICTIM/WITRESSES CAII BE coNTACTED EY DAY INYESTIGATORS IF NO AVAILABLE PHCNE NUNBERS_
Zhs 4ZA-_c @scZoscec Ee_ebozs
2sz Z2z LlicaU
Je*
EhacZ
ZaskifecTZL2zaezxz
Xazessh
4
22
1 LE_
2y1_Zbes_abokep-
~~
467/
Zppegr2s
~5 CSL
22_042
4
252414472232
2_Kaa SuiSse_fpz 24245722
~U-Z_c XSzrWe 44_L_oen,A
bzz_ELahz ef,SuspWss_
4pprelen-
1 ~SSe_ 4222 Iacmed
3l_
#qiScerc
21-J462)
4742i+S7224
~2s24LMe2
30
~kzh_e 2xZ7: 4Ailze Fdlf GoE
2shb
CRJXE CLEARED 8Y KRREST YES NO IF adsiticnsl Spaca i rcuired, U52 Cowlinuzlion Sezt, Ferm 15.9_
APP; JERIAL 0 TTERWiewiiTG OFFIczR(S)- SER" :. CIV. DETc PERSOFT TErCRTIiG CRi E (Sicnziure)
OAFE & TIiiz REPROONCEE oivis
28j
CLEARED EY
Matple Rapbett
Zpit
FOLLOw-UP DR
foral 3.10 (iat [Bc . 1767) MiSCELANEQuS COXPIANNT OR CRixE REPCRT I#DZXE? GhIekic
RJpe =
6-15
O5
{ices
Lari
Ln_o
7ZZrz
b21 _
bilyel
Xeat
77uo
Xo
==================================================
Page 15
==================================================
Los Angeles Policc Depariincrif TAIETF TEcESE0 7LZ T-i, -mnkidle)
SHez DEATN: RREPOR FiTeI KENNEP DBEET
Rriy DR; 52114
SEX DESCERT Au TEFGRT Toc Tion OF DCCURRETCE RPT. DIST, TYPE (Tf, nze -hom ) 8FSGECER320] _
0F
/oC 2 2/0 [3L=lzZ2 242H2xtL
WETGHT HRIR EYES EUTLD COMPLEXTON LOCATION %F (RICINAL ILLMESS OR INJWRY RPT. DIST_ TYPE ORIG_ REPORI
ZLl leeu Dii 2402 WiLzAIZE 23
LUENTIFYING N7RKS AND CHARACTERiSTiCS DA) ETTIRE DECEASED DSCIVERED DATE/TTE DEAT OTCURRED DATETTINE RPTD. To P.D_ 6-b-bb[
CLOTMNG AND JEVFECRY VFORI TMTEjME ORIGIAL TELZMJ OCCUPATIOT 0F DECEASEO RELATIVES FOTIFIED BY
SSZ4214
REMOVED To7ARdres;} RERTOVED BY (Unit indiv)
223Z
DECEASED RESIDENCE ADDRESS PROBABLE CAUSE 0F OEATR REASUFI (Qurrel-Tlingss-fevenge Clc,.
342 UIL SEe_Bf2 2A? 27/42
DECEASED BUSINESS ADDPESS TNVESTIGATIVE DivisioNis) UR UNTTTS) NOTTFTED AND PERSOT(S) CONTAGTED
0242
CODE: R-PERsON REPORTING DEATH D-PERSON DISCOVERING DECEASED I-PERSON IDENTiFYING DECEASED W-WITNESS
MEAREST RELATIVE RELATIOISHIP CODE RESIDENCE ADORESS CITY RES. PHONE X BUS _ PHONE
KuneEYEIHEL (LEn 32/22i-EULLERZe
31 neuzas'
NAME
DOCTOR 7M ATTENDANCE BUSINESS ADDRESS
EnEY CYNE Sh37TG
(1) RECONSTRUCT THE CIRCUMSTANCES SURROWNDING TKE DENTR, 72) DESCRIEE PiNVSICAL EVTDENCE, TOCATION FouNo RND GIVE DISPOSITION:
RJoZe=.eu2ez
4Z/2Z
4268ZL_D2 22x_2
LelmfR_e_ Z2 OElI
2enAEy__Tfe_Qc
1
SJIIHESz
ecsWi4 TREREMEELLC 5Les4423
LeCE2s_ 2E3_22_3022V244C2
DEAp_EL_J4ud22;_lS-ez 24.22_Heed
Lumee_SZZFI 422.
DETHDILIS_ACEzianZEEZEE
CeIEESC
7z-273
additional sgac? is resuired use Colliruatiol Shset; Fortn 15.9_
SUPERVISOR APP? SERIAL Ro_ INTERVIEVING OFFiCER{S} SER_ #O. DIV. DETL PERSOH REPORTING DFATH (Signaturz}
DRSTEL A2 '76d7 "wp|
X
DATE TRE REPRODUEED DWVISION CLERX INDEXED CHECKED
(32eL b, JR!Z1lw
Fcrn 3.11 (Rev, Jan '62) DaATW REPORT 288
6_6
==================================================
Page 16
==================================================
Los Angeie: roiice Uzparimenr
MISCELLANEOUS CoM INT Or vicTIM"S NAME (Last-Firsl-middie_ nale if business)
2Zs CRIME REPO= 1
KEAMEDL Zer ErancLs DRLZS2L46_
WFAPON,FORCE OR MEANS USED (Dzscribe cal , ype, elc,) TYPE (Mur-Sial, Rape-Batt , etc )
22 LAL' Kc_ALvcr? Wuvdek
APPRRENT MOTIVE LOCATION &F OCCURRENCE REPORTING DIST.
UNX WlLsIirc F4vD S"1.
No. OF SUSPECTS SEX, DESCENT DATE NlD TIME OCCURREO DATE AND TMME REPORTED TO P;o
4 'L-te8 LYHAm_ "YAw
TRADEMARKS 0F SUSPECTUS) (Aclions or converstion) YPE OF PREMISES
SHoy VcT Ju YmesAs He KmeL:SADeR He
TNVESTIGATIVE DIVISTONS) 0n UNiT(S) NOTIFTED AND PERSON(S) CONTACTED
LBTC GALL QoovAT THe KeTeL Abo A6
VEHICLE USED BV SUSPECTI(S) - (Yr-make-body-col-Tic. no.& I.D,J) LTST AnY CONNECTING RPTTS) , BY TYPE AND DR NO VICTIM'S COND. (HBD, NORMAL, ETC,)
ATTw}T.mue.REI-b& 42Luc NornA &
COpE: V_vicTiM R-PERSON REPORTING CRIME W_WITNESS
VICTIMS OCCUPATION SEX DESCENT DATE OF BIRTH CODE RESIDENCE ADDRESS (Bus add_ if firm) CITY RES . PHONE BUS: PHONE
LS_SEnATe meua H2YPsL "7*00 QUILSHRe ;Ylub LA
2utrisatz?
NAME REE1,Ko85n44_ LJ-/ 34)_WlLsHna JSkvn_ hk 033 70357?yn
Tinseu_PAEEn W-21 1L Ll
TDENTIFY SUSPECTIS) BY No TName-address-szx-dcscent-age-hL-Wl-hair-cyes-complexion-clclhing-identilying characlerislics. Tf arrested, @nclude no. & charge.)
1 SIHlANASIHAA KLSHARA WrpAualy 7-/?-44, Sz_,1l4- LK-Bed
66_4 #ouAlr PAsDenA
TI) TDENTTFY ADDITTONAL SUSPECTS) . 72) RECONSTRUCT THE CRMME 73) DESCRIBE PHYSTCAC EVIDENCE_ LOcATTON FOUND , AND GIVE DISPOSTTION_ (a) SUMMARTZE OTHER
DETAILS RELATING To CRIME: (5) TIME AND LOCATIOM WKERE VICTIM /WITNESSES CAN BE CONTACTED BY DAY INVESTIGATORS IF NO AVAILABLE PHONE NUMBERS_
Vec HD_TusI @QwELe@Er_A_PolLTAAL_SPeEelane
WAS JAAVG_Zle__ALL_Reem_AIIHEAmE4SADen_Holel
1Y_wY_6f_ HiL_WAY_SirezeLTle_Kielen_Arert.Yhe
Akeve e4Peet__uS (MIl_JL_ue KIIle_ARelu-As_
Ju__ANE_ezey _CevAeNs_APrneAlad_SReuLlIde tell-
LAy_ JPec_EWeaR EbUt_Slefs_N RApt BUeeR:sJN
Zuo QH_Thle__tleZi_HReQ SydUCk_WeC_QneI"Jle
HeA?__Nean_te 3_
S#tEAr;Iile_ether_IuTe_aeec
SHeLdeny__VeE_WUALSabek; To_eenE Rec_Hes
1y AweaMeey_EMeb_Lc-NLY Y2sL me"s_WKS CVe4
By TacloRs__A_QeNT_rec_HofB;JcT_uLKS_Yeu SPllferi
SSAMA@IllL:_F_FUIe Ilum YROTmSulzJLCTE
Passe LAWALAAC_EeeDSALAnSAl_psp_AI_ALPRA
iAM_(-4 -G&,_S_A Reine 0f Gui_SletWelie_
RUSTANed_A
SAIoVox(Bv KreseN__A @rifbf
DAATI_Hen_uaop_ SyAfA_ DR-A_Gee2 :4mIl
#esp(aly
CRIME CLEARED BX ARREST YES NO If arditional space is required, use Contjnualion Sheet, Form 15.9_
SUPERVISOR APPROVING SERIAL No. TNTERVTEWTNG OFF}CER(S) SER, No. DIV_ DETL_ PERSON REPORTING CRIME Signature)
~1
Q BUnite 7474
DATE & FiME REFRODUCED DIVISION CLERK CLEARED BY MULTIPLE
734 6/5//} 289
RAmr,0e?
FOL.LOw-UP DR
Forin 3.10 (Rev. Dec. 1967) MISCELLANEOUS COMPLAINT Oi CRIME REPORT INDEXED CKECKED
Bkg:
St
==================================================
Page 17
==================================================
MISCELLANEOUS COMPLAINT OR Picthm"$ NAMTE (Last-first-niidalc: Firm_name "Tf business)
2k425 CRime REPORT 4ScHARe
DR 22)466
WEAPON, FORCE OR MEANS USED (Dcscribe cal_ TYPE (Flur -~al . Rape-Batt,, elc,)
2 AS Muzpe
GPrARENT ATOTIVE iocaTioi 0f OCCURRENCE REPORTING DiST_
4 23421
No. OF SUSPECTS SEX, DESCENT DATE TNd TME OCCURRED DATE ANd TMME REPORTED To PD.
X= A4€
JaeevAX
#y1
TRADEMARKS 0F SUSPECT(S) (Actions 0r comersation) TYFE OF FREMTSES
Mau X 72 AURDEZ S1
TNESTIGATTVE DIVISTONTS) OR UNTTTS) NOTTFED AND PERSONTS) CONTACTED
AN2LZA
VEHICLE USED BY SUSPECTTS) (Yr-makc-body-col-lic . no_ € TD) ZiST ANY CONNECTING RPT(S) . BY TYPE AND DR No_ VICTIM'S Cond. (HBD, NORMAL, ETc))
ZZZAZZER 2zez
24143
CODE: V-VicTIM R-PERSON REPORTING CRImE W_WITNESS
AREAS422S 68-3zv#ee
VICTIM'S OCCuPATION SEX DESCENT DATE 0F BIRTH CODE RESIDENCE ADDRESS (Bus add_ if firm) CITY RES. PHONE X BUS. PHONE
UN-O OEZSZ: 450SHalc8sxT22
NAME
TDENTIFY SUSPECTCS) BY Mo_ TName-address-sex-descent-age-hl-W-hair-cyes-complexion-clothing-idenlifying characterisiics f arrested_ include no. charge.=
1 Sels LxsHA2A AAE1c 9_ 3 24X_2ex
2 A2s232
(1) TDENTIFY ADDITTONAL SUSPECTIS) . (2) RECONSTRUCT" THE CRTME 73) DESCRIBE PHYSTCAL EVIDENCE COCATTON FOUND , AND GIVE DISPOSITION_ () SUMMARIZE OTHER
DETAILS RELATING To CRIME_ (5) TIME AND LOCATION WHERE VICTIM /WITNESSES CAN BE CONTACTED BY DAY INVESTIGATORS IF NO AVAILABLE PHIONE NUMBERS.
12azz_
Vx prt
2
E-Zi_zz
22224
~43u Vt23zl
CRIKECLEARED BX ARRESJ YES No If additiona'e ace is required, usc SShtinuatrol Skeez; Form 15,9.
SUPERVJSIR APPROVING SERIAL No. TNTERVIEWING OFT; CER(S) SER. No_ DIV _ DETL PERSON REPORTING CRIME (Sigalure)
7608 il2
DATE & TIME RERGOMUCED DIVISION CLERK CLEARED BY MULTIPLE
/ ; '4222
FOLLOW-UP DR
Form 3.10 (Rev. Dec_ 1967) MISCELLANEOUS COMPLAINT OR CRIME REPORT INDEXEQ CHECKED
522
bkg;
2s
==================================================
Page 18
==================================================
L0S nyuies Uiicc Nlewarim}I
MISCELLANEOUS COMP} JNT Or Victiiz s I7ME (ast-Tirst-middle. paric if busincss)
CiRIs CRIME REPof E44220 1.
~TZiol WLA N qt
DR
531424
@EAiL ?oRc 0i} MEANS USED (Describe cal {ype, Pef TYPE (Mur-Siat; Rapc-Ball,, elc )
02 RrV3lr
2. 42L Muvdz
APPARENT MROTIVE LOcntion CF OCCURRENCE REPORTING DIST
UNkUown 3400
Ukh
0
Si
NO. OF SUSPECTS SEX , DESCELLT DRTE AND TIME OCCURREN" DATE ANO YIME REPORTED To P
Uale erAdtldu4_
~+
5-(
i2 'A4
6
5orpM
TRADEMARKS 0F SUSPECT(S) (Aclions or conyersalion) TYPr 0F PREMISES
Muvdkvz
6
Lekss: f-v
Kiteb
ec
TNVESTIGATIVE DIVISTONTS) OR UNIT(S) NOTIFIED AND PERSONTS) CCWTACTED duzli &xte
VEMICLE USED BY SUSPECTIS) ~(Yr-Rlake-body-col-Tic no. rTDJ UTST ARY CONNECTING FPT(S). BY TYPE AND D R No_ VICTIM'S COND. (HBD, NORMAL, ETC )
MuROEZR? Cal~ Norwwl
CODE: V-VIctik R-PERSON REF'ORTING CRIME TNESS VPII
VicTInTS OCCUPATION SEX DESCENT DATE OF. BIRTH RESIDENCE ADDRESS (Bus_ add_ il firm) CITY RES BUS. PHONE
STUBEt M-Cauc
MZL
6 6%e Horn
[7
NAIAE
ES44 0 _aM L4! 0 63z IAkunt_Naax (6l
Str2L A 8 Je Exliol La k & 35374
0 EKeyCiut_ (AalL
1 (
TDENTIFY SUSPECTTS) BY No. TName-address-sex-dcsceni-ag?-hi-wt-hair-eyes-complexion-clothing-iden ifying characterislics_ If arrested, irclude bkg- no. & charge
1 Si dAA SihezBiahdrs H,
4
3-4
0
44 5 2 B_ bvM
2 Blv
Ul&
498 73
(1) TDENTIFY ADDTTYONAL SUSPECTIS). 72) RECONSTRUCT THE CRIRE _ 73) DESCRIBE ' PHYSTCAL EVIDENCE _ LOCATTON FOUND_ AND GIVE DISPOSTTTOM_ 7q) SuMnTARIZE OTHER
DETAILS RELATING To CRIME (5) TIME AND LOCATION WHERE VICTIM /WITHESSES CAN BE CONTACTED BY DAY INVESTIGATORS IF NO AVAILABLE PIIONE NUmBERS.
VLs_T_Wd_ SayrpdL-s Lua _ key_ e_Kes a
ilzalsy_-
k_eue_6 U
b2__Ltt_@ EsqtL
Lcy
Gu
bu, #Le_oer_4d
40-
#e_ebL4l _dtg
MLA
Lk_ctbg Awbese_ev Hlzau_A*oske
b
ulbl_Lc
ustv_ ea-w
8444 0o4li Jrwva-xtedee_Ebkise)_Qy_Yavu
A4 " Jazv_ T
E
__shert_Rk #_8ele- € _
Ll
LEY_
Yuo~_+ue_kec 2Nj-Id
La_Gelldiz frdl
proceede_ 22 =ekklel:
A2 / _
~Ilct_Sts
M
se_Avfupe
@l L4 $ L
4 -2_ea4
s/1&a
3
N~h-Sa
Ars__ keiziealy+_ _eer_Zsk_affev_&boue_uut
Stbl_etrrel kikde_arr_ ~g
CAnsk _ d
abrt
pelrt &+cL= Hewve wei
ft
he `
Heqtf
4 LsLL_4 Kllc _
Slresradlerz_42_ ~_flt_es_€ Somfule &ke Ji
Yhe_Kazx:
See%_ Fuask_ha_ elsevueq_Stoke_-=ts
L 6
#ivued_+Kict sbul
LuaS
YbskrLhacl
fus #uaeti
barv _ Ukyaie_ h e dlscs Ae__ul shat
1y
alek
_Vct_STR LL_Ac
LLLl?dl
WrLEsAAL
uis
4
IELseortel_+_CeAt
~Uti
ell2i _ 269-
4lls CiEh-_ Mct_L_stbar
CRIME CLEARED BY ARREST YES No If adzitional spacc is reruired, USC Continualion Shecl, Form 15.5 Corl
SUrF SERIAL No_ TNTERVIEWITG" OFFICE R(s) SER NO . D. dETL_ PERSOR REPORITIG CRIE (Signalure) 7247#
~b DATE & TIE {REPRODicED - vivisTon- CLERK CLEARED BY MULTiPLE
FOLLOW-UP DR
Fum 3.10 {% Dec 1767; MRSCELLANEOUS Com?iATNT OR CRine REPORT iNDEXED CHECZEd
(sl
0 @
I: IH+
L}
05 Cl
kaszk
Sb
bes
LtA
d
ReS
~rt
credy
t4-
Lzt? ~y
2
==================================================
Page 19
==================================================
Los Angeles Police Department CONTINUATION SHEET
PAGE Ro. TYPE OF IRFPORT BOOKING NO_ DR @O:
"T6:
QUAH:
Lurlev_VICL SIRel
5214L4
SERISL HUZBERS
#e_(Jds Ias
Rodhs
1_KulWla ~aVs
Y= 4
_ke g 4401 @s4 Ci_CrzEN_
tl
@Y_
ZEFFF Pesl_
342 Loiv+ 21
RSIe_
XNRY+_
Rlens SaluaeY
ReudEikewuedy
Stephg_Sntt
Iirsfr_IFLS
Eres_
44et4
~Vck_ STRAIZ
Me< RyKeyee
LTes-z _Grez
Wfn-s<_+8f14_EEI;or
225
44_-
I6-24l
uabatl_GrexQ
M
~_t2_ Lsw 1A _S
E Feszbze
8 ssht_Uscf Uecthex u
#t_SolYe ~ex_F ac `
Hsles L'_Ner d8_ S KCec_d
geelu?
so
rerrescabyi Aeaus_Phele 5
~bela EilaAAZ-LL_
292
Forn 15.4 (Rey. July '65) CONTINUATION Shett
8+
Vee
333
04
4
==================================================
Page 20
==================================================
MICELANEOUS COMRLAINS VICMN $ Damf (Lasl-tirst-mniduic. +irm nare ! busiriess)
3225 CRIME REPORT DR
WEAPO;, FORCE OR MEANS USED (Describe cal TYPE (Mur-Sial Rape-Ball , eic,)
04 SZI {MuRDEs
TPPKRENT MOTIVE LOCATION 0F UCCURRERCE REFORTING DIST.
22
NO. 0F SUSPECTS SEX, DESCENT TTe AMD "TIE QCCURRED DATE AND TIME REPORTED To P._
32 3
TRKDEMARKS 0F SUSPECTTS) (Activn; 6f comiversatini Y?z F TRKMTSES
tr: 0 UeDE
TFESTiGKTIVE DiVISTOMTS) OR WMTiS) NOTIFIED AND PERSOM(S) CONTACTED
24CA
VEMICLE USED BY SUSPECT(S) -(Yr-make-bod;-col-Tic . 1o #1. TTST ANT TUTINECTING RPTUS) . BY TYPE ND D R MO VICTIZ;'S COND. (HBD, NORMAL; ETC )
2 Noeh
CODE: V-ViCTIM 7-PETSoN Reporting CRIae W_WItNES 23z ~
0/7/72 @ef-54/266
VICTIM'S OCCUPATION SEX DESCENT DATE OF BiRTII CODE RESIDENCE AUDRESS (Bus add_ if firm) CITY RES . PRONE X BUS PHONE
Tki WAs,2Skbs2y
MAME
22212cZOE ZVe N4s, 23272d
Ac
4 4x37702
TDENTIFY SUSPECTCS) BY Mo. (Name-address-sex-dcsceit-age-Tl-'l-haif-zyzs-compfexicn-clolhing-Tdentilying characteristics Tf arrested, include bkg: no. & chargz
1 22a8
2 #E732
71) DDENTIFY ADDITTONAL SUSPECT S) . 72) RECONSTRUCT THF CRIME 7(3) DESTRIRE PHYSTCAL EVTDENCE _ ZocatiQn FOUND_ AMD GIVE DISPOSITTON_ 74) SUIARIZE OTHER
DETAILS RFLATING To CRIME. (5) TIME AMD LOCATION IVKERE VICTIM/WITNESSES CAN BE CONTACTED BY DAY INVESTIGATORS' IF NO AVAILABLE PKONE NUMBEFS
3*4
nceL7
SX)
03
CRIME CLEARED BX ARREST YES No Ii audilicral spacc is required, #sc Conlinuation She-t, Forui 15.9.
SUFERVJSER APPRQVING SERIAL No. TNTERVIEWING oFijczrs) SER; NO. Div. DETL PERSOW REPORTING CRIME (sigua ure)
4382
DATE 6" TIIE REPREPTTED ~ DIVISIOTT CLERV CLEARED EY MUi TIPLE
FCLLOW-UP DR
Form 3.10 (Rex Dec. 1967) MISCELLANEODS CuPLAINT OR CRME REport INDEX5R CXFCKEI:
c
==================================================
Page 21
==================================================
MISCELLANEOUS"COMPIATNT QR ViCTiM"s "NAME Lasi-first-iddlc. Firm name Tf business)
CRIME REPORT
I_
_Afs DR23152!YLesld
WEAPON, FORCE OR MEANS USED (Describc cal, typ TYPE (Mur-Stal Rape-Balt , clc _)
2
2/1 /0
APPARENT
MF onV #
ZOCATION OF OCCURRENCE REPORTING DIST.
N #li-nE H ~-
CTIM"S COND . (HBD , normlal , etc_= SUSPECT(S) TO . S3 DESCENT DATE AnD TIME OCCURRED DATE ANn" TIME REPORTED ToPD,
Np2:i Etontionz?_L2
TRADEMARRS QF SUSPECT(S) (Aclions or conversation} TYPE OF
[21z2_121 AfV ziel Hzlz
E4 fEf
TNVESTIGATTVE
DiViSiONtS) OR UNITIS) NOTIFIED ANo-PERSONTS) CONTACTED
4Z2 cpo Zeui!Z_ VNYiEI4
VEHICLE USED BY SUSPECT(S) "WYr-makc-body-co]-@ic: n.€TD) LiST ANY CONNECTNNG RPTIS). BY TYPE AnD D R No ,
71p Lle
77 ELLZ
CODE: V-victim F-PERSON REPORTING CRIME w--WITNESS
VICTIMS OCCUPATION SEX DESCENT DATE OF BIRTH CODE RESIDENCE ADDRESS (Bus. add, if firm) CITY RES ,'" PHIONE Y BUS. PHOME X
{ / J) XJa
NATE
LeziALzEz PII E2
COLEN_Rebin 7, V2Z2fexeID_kus
TDENTIFY SUSPECT(S) BY NO_ (anie-address-sex-descent-ag2 ht-Wt-hair-eyes-complexion-clolhing-identifying characteristics Tr arrested, Tnclude Fkg no. & charge,)
1 POE LTAMN# 78 A 22 HLLiz_
An 2 / 7 Pc
(1) TDENTIFY ADDITTONAL SUSPECTTS) 72) RECONSTRUCT TIE CRIME. 73) DESCRTBE PHYSICAL'" EVIDENCE; LOCATIoW FoUNo, TAND GWVE" DiSPSiTIoN 74) SUMMARIZE "TITER
DETAILS RELATING To CRIME_ (5) TIME AND LOCATION WHERE VICTIM /WITNESSES CAN BE CONTACTED BY DAY INVESTIGATORS JF NO AVAILABLE PHONE NUMBERS_
Z2_ELf_IIm_iZLLELEA4_ Celle
622 _Ge2re_EDe_leLAAKlie_fLz:
441
ZnXlea_ell__DL_VLA_ze2l21z2 @aec
El1lez_Y_Z1e4z_2Zlze F2eb_zn__LeslZer
AZ_ZZ2eps_
61
e&e_I_ZszzeL4_#
PZeesL &40_CfCzl_k2zee e_2914Q 211E-
Vcz_ASEER_AZier_Leli ZBzL-AQYfeG
2o
BEJfA_EUZie_ SEZ#L_EICE -ijsz_ezi 0 ~
VesIerl _ WDere_Sslzelnedy_42zz_222 2
EZIZ_eWfA_i_Ifi_EVfzbYoc_s_biz__}ekChz
LxLEE_2zEe:z_Zdz_Iziz 4Zej 7
E222
E__nse__ZOz_JCL z_LGrE_E Zh_oZtzc
dzLuzElf_EZbEE_Zez2eA_UWEk__lezkaze)
fle_4EQ_Ifs_ALIzA_ Jyi_.iee_Paees _ls
_
Ihba_ZelKEZ2_ Zezrez_ey_iz__222k_22z
21 Iel_ZCi_ifneZKo_ZZnf 2+62 I2Z_Z7DZI4_1o3
E_WfkbbzbUeE_i_Ofcz_AZZ_Zeiyl_Jlz_27222
LLYQZ_ZEe ZILE 2Z12ZQ_0 /ET2ZE_If
2/2ZZZi 42
2C8n 4ezzs2
MISDEMEANOR CRIME CLEARED BY ARREsT YES NC If additiomal space is required, Use Conlinuation Shcel, Form 15.9_
SUPERVISOR AFPRIVIDG SERIAL No_ TTERVIEWING OFFICER(S) SER: No; DIV_ DETL PERSON REPORTING CRIRE (Zlgnature
71-j1-4
5D{ Vid
DATE & TIME REPRODUCED TVISTON CLERK CLEARED 6Y Miltipie
C
62/22
FOLLOW-Up DX
Fori 3.10 (Rev. Jane 1466} MISCELLANEQUS COMPLAINT OR Crime REPOnT INDZXED
23+
Ge;tn
134
) !
Nu
2623_24
==================================================
Page 22
==================================================
Los Angcles Police Deparlmcnt CONTINUATION SHCET
PAGE Flo_ TYPE 0F REPORT Booking No Di No.
IteM
No. QUAn:
2A 15ZaS 6852ek
SERIAL MUADGRS
8292 Zeezmeri_eE__u2zlez
+-woyzd_
80z3rs8eer77e
~
ZAck ULlsz
~zEif1_E_LAZr2n2_14L4BYLEZ_fzzly
#ALe#BLE__iL EZ_kl4
Fvtii 15.3 (ci, &tiz '65) CONTINUATICN SxEet
==================================================
Page 23
==================================================
LUs niieies ruiicu ucparmert CKECK ONE Fouid Founa
SHOTS PROPERTY REPORT TYPE ONLY
Jujvidence D Evidencc Rrty Safckccping DR
F' Ip BEENcE MQDRESS PERSO# PROPERTY LOOKED TO (Last-f; middle) RFS. PHONE FUS, PIRONE
1.
T2A15.
1.
-ehx_ZQz 4F
RESIDERCE ADDRESS ARRESTEES MAHE CHARGE BKG . RO.
2. 22 Palssh432
ASIDENCE ADDReSS VICTIM ORr OWNERT MAME RES, PHONE BUS. PIIOME
3 3.
RESTDENCE ADDRESS PIMSO' REPORTING To POLICE DEPT. (Lasl, FirsL, Middle) RES. PHONE BUS. PKONE
4 4
DATE & TIME THIS REPORT PROR: BKD. AT INV. DV DATE & TIME PROPERTY TAKEN INTO POLICE CUSTODY LOCATION CITY OR REPORTING DIST.
RAM
DFT
Evidcncc: TXQ OF PREMISES TYPE OF PROPERTY DJV. RPTG. BooK to ARRESTEE: IF NONE, BOOK To VICTIM.
Found Exidcnce: BOOK TO OFFICER IF NO ARRESTEE OR VICTIH_
Found Propcrty: Book< To ACTUAL FINDER_ DIV . OR CITY & DATE CRIME OCCURRED LIST ANY CONNECTIHG RFPORTS BY,TYPE && DRS
Safekccping: BOOK To DEPOSITOR, OWNER OR /'ERSON IN LAWFUL
POSSESSION TS THIS STOLEN PROPERTY? PROBABLE CRIME Prinls Phota S.D. Other (Scparate rcports are required for each diffcrent
classificafion of propcrty) YES NO UNKNOWN
(1) IF STOLEN TN CITY 0F Los ANGELES EACH CASE MUST BE COVERED BY CRIME AND Foilow-Up REPORTS (2) DESCRIBE CIRCUMSTANCES RESULTING IN BOOKING 0F THIS PROP_
ERTY_ (3) GIVE ADDRESS TIME AND/OR PHONE NUMBER WHERE CONCERNED PERSONCS) MAY BE CONTACTED BY DAY [NVESTIGATORS
ITEM QUAN- JF Not OR OTHER TKAN ABOVE (4) ITEMIZE AND DESCRIBE ALL PROPERTY GIVE ALL SERIAL NUMBERS AND OTHER MARKS SERIAI TUMBER(S)
NO. TITY OF
NOEN STERTOR "
LIST ONLY ONE ARTICLE ON A LINE AND ENGRAVING
Wi 2peff 2_w2ia_L222ou
282232025-H osse_DLi
L++BE 22xi+zce4
42E2222f52 414415.3
5
Efzs
Lezid_S_
7
We}Zt_%LL
4822230
~iZ
C_
12_ob
Fzz_Zu_4l
~ecn
[Ex1
V4e22_082 @_ZEL
If addilicnal space is required, Use Conliauallon Shzel, Fcrm 15.9.
SUPERVISQR APPROV}NG SERiAL Mo. REPORTING OFFICERCS} SER. NO. DIV . DETL_ PERSQN REPORITNG (Signaturp) Llcket7
Dx/r 77k {Rs0r X;
DATF & TMME REPRODUCED DIVISION CLERK 1e,58 INDEXED CIECKED
b6-Lof" e) 1bevU A
Fcrmi Ju.l (Nev. Fcb, 1463) PMoPERTT EEPORT
Vel
==================================================
Page 24
==================================================
Los Angeles Police Department CMECK ONE Found Found
PROPERTY REPORT. TYPE ONLY Evidcnce Evidcncc rty 0 Safekccping
DRG8<a1
4
RESIDENCE ADoRESS TERsoN PROPiiT { Booked TQ (Last-mirs Iddlc) RES, PIONE BUS. PHONE
1_
{2~re
1. 01 J24q
RESTDENCE ^DDRESS ARRESTECS MARE CHARGE BKG. No.
2 4F
SiDENCE ADDRESS ViCTIM OR @IMTERS TAME RES PIIONE BUS. PHONE
3 3_ Lide2u4
RESIDEMCE ADDRESS PERSON Rrforting To POLICE DEPT. (Last_ First, Middle) RES. PI{ONE BUS. PMORE
1_ 1
ALl 'Uic
DATE & TIME ThIS REPORT PROP. BKD, AT 1nV_ DIV_ DATE & TImE PROPERTY TakEN INto PoliCE CUSTody LocaTiON CITY OR REPORTING DiST.
(2 (o' 5v] ~iw/ ic: 68 4x2 tWeeT Lvis 22
Evidcncc: BookK To ARRESTEE. IF NONE, Book To VICTIM. TYPE OF PREMIISES TYPE OF PROPERTY DIV. RPTG.
Found Eyidencc: Book TO OFFICER IF No ARRISTEE OR VictIM_ 7'' 04+'E0_- MCC}
Found Propcrty: cook To ACTUAL FINDER DIV_ CR City & DATE CRIME OCCURRED LIST ANY CONNECTING REPORTS BY JYFF & DR
Safekkecping: Book To DEPOSITOR, OWNER OR PERSON IN LAIFUL 4z 01-Zi 07 VW;k
POSSESSiON TS THIS STOLEN PROPERTY? PROBAELE CRIME Prinls Pholo S.D: Olher (Scparate rcporks arc rcquircd for cach diffcrcnt
classification of propcrty) YES No Unknovin 1 M4Yl
T1) TF STOLEN TN CITY 0F Los ANCELES EACH CASE MuST BE CVERED BY' CRIiE AND FOLLOw-UP REPORTS_ 72) DESCRIBE CIRCUMSTANCES RESULTING IN BOOKING 0F THIS PROP-
ERTY. (3) GIVE ADDRESS Time AND/OR Pkone Nutber IVMERE CONCERNED PERSON(S) MAY B ConTACTED BY DAY INVESTIGATORS
Ttem QUAN- TF Not LiSTEd, Or OTHER ThAII ABOVE (4) ITEMIZE And DESCRIBE ALL PROPERTY. GIVE ALL SERIAL NUMBERS AND OTHER MARKS SERTAL NUMBER(S)
No_ TIty OF IdEntiFiCATiON_ LIST ONLY OWE ARTICLE ON 4 LINE. AND ENGRAVING
fxi
_
78y S+EXIEUEC Q1_2a 04
NcCLYEkLFFo_
OBLisi Fby
730 Qw
PAerIAi b_As= fi 25
JLeldd_22oxi}4E2
Kz-y
I
DeLioy_le-S__eSAT
Ciewr@uili_GWSUE0_O6LeclC_ Laclli
_e8JZGN SIIfDPzC
Csij"
EExEE Cie
Jf addilional space is .equircc , csc Conlinallon Shee:, Forni 15.9_
SUPERVISOR APPRQVING SERIAC No; REPORTING OFFTCER(S) SER; NO. DJV_ DETL PERSON REPORTING (Signalure)
+-x9 7287 HaX_
LATE & Timz REPRODUCEO DIVISIOR CLeRK INDEXED CFIECKED 252337472281
(j
M EvJiv 10.329
Foim 10.1 (Ry. Feb. 1933) PROPERTY REPORT
6b
RT
(ili
CNL
{GO
3IS
==================================================
Page 25
==================================================
Eots FFzef
StbFs Los Angcles Police Department CNECK ONE Evidence Foundl Founa
r
red PROPERTY REPORT TYPE ONLY Evidencc pperty Safckecping 68- 5244l6
RESIDENCE ADDRESS PERSON PROPERTY BOOKED TO (Last middle) RES , PHIONE BUS. PHONE
TAN<eJT_
1_
DC JoHln NMI Ukc Unic
RESIDENCE ADDRESS ARRESTEES NATHE CHARGE @KG, Nio.
KGCGw iNT"
2 n 496 139
~SIDENCE ADDRESS VICTTm OR UVNER'S MAME RES, PHOME BUS. PHONE
3_ 3
IcAnNGDYLYeeezt_
RESIDENCE ADDRESS PERSON REPORTING TO POLICE DEPT. (Lasl, First, Middle) RES. PHQNE BUS, PKONE
4
IS:.(J , Ls Nocles St" L:; 4. {2e4cLLD2 68 h42921
DATE & TIME TMIS REPORT PROP. BKD. AT DIV_ DATE & TIME PROPERTY TAKEN INTO POLTCE CUSTODY ZOCATION CITY OR REPORTING DIST
LiS-L
3FA[Ean ETTER
_S-bg- AL4z42 W SHTTD_
Exidence: BOOK TO ARRESTEE. IF NONE, BOOK TO VICTIM TYPE QF PREMISES TYPE OF PROPERTY DIV . RPTG.
Found Eridencc: BOOK TO OFFICER IF NO ARRESTEE OR VICTIM.
Hoskt
Itrd
07enJG/islcod SAytlec c
HECzo
Found Property: BOOK TO ACTUAL FINDER: DIV. OR CITY & DATE CRIME OCCURRED LIST ANY CONNECTING REPORTS BY TYPE & DR:
Safckecping: BOQK TQ DEPOSITOR, OWNER OR PERSON IN LAWFUL hs; 6-4-68 Cynaicc IOttd '5214l6
PosSESSION;
TS THIS STOLEN PROPERTY? PROBABLE CRIME Prinls Photo S..D. Other (Separate reports arc required for cach differcnt_
classification of property) YES NO UNKNOWM nk
(1) IF STOLEN IN CITY OF Tos ANGELES EACH CASE Must BE COVERED BY CRIME AND FOLLOW-UP REPORTS. 72) DESCRTBE CIRCUMSTANCES RESULTING IN BOOKING 0F THIS PROP
ERTY: (3) GIVE ADDRESS TIME AND/OR PHONE NUMBER WHERE CONCERNED PERSON(S) MAY BE CONTACTED BY DAY [NVESTIGATORS
TTEM 'QUAN- IF NOT LiSTED, OR OTHER THAN ABovE_ (4) ITEMIZE AND DESCRIBE ALL PROPERTY. GIVE ALL SERIAL NUMBERS AND OTHER MARKS SERTAL NUMBERTS)
NO_ TITY 0F IDENTIFICATION_ LIST ONLY ONE ARTICLE ON A LINE AND ENGRAVING
IheZ4lALLSAlQIAAAC Jubs_IeeGLVed
QFc_IZoAE:IAAULU(MEEeulAt_Thle_Gpen
SMARBIn_doselh_W_SLLtTe+ADApieoETc4
I_Weame4e_VSssAktBkce_euleNeel__
7 7 C535 SUMA FEEGDEZ)
LE Slikl
ITeMs%l1_IR_beL2e_E_VE Lezelez_uSea_eyWS
Fxqeeges
m 2 II
@Ls"Eere Dwiluy_Stz_ BLiSE(WLFLoe sa-ke
"Hits(Mil "E4LR-As(l Wlr_clo74l,E126 426 (BLovDSTA Jcb
IS 4+SUl MNIAIg_LJLaLue " MMivr (LIE_swe)HcEi (ev1i-e-Szukt
1 Jp ##Elwsl 32 *eVSTt_illiak BlLli-'_ReWAmSLLc VTHEL
44_(wed) "eVfT2 V ELS_k/sLLves_-Sje pes
CC_ ~5
1r 4 [ SocEs(PeLusL(v_LI_
W Lt J= T -PhgL BA (@JANCA DoLi_ehal(sc2vm SILcLwsckNcLe)+_
4 25 ~Buttle (614 "4"4Ei
1
(AyfLyns_" JecESt_vmA_BunL_wjsblHese (tINlie
2 NNLa(4NDEAV_eusLeesTALL4LY_PlDeJOLose_wlwuTJADs __
2
24sHcers (ceslykeVlBlue Srgipe(Auec Hosp) ELbobsrhues
22
~vaLlclssl_Cori(CuNis LL &s4ic2S444064 LEWL-Lktuy)
061 1JVAL(Elass)"L ukJez_cexzzis_8eicet_Bli Eb24~Z
L_vibGbsl__E2Itz _e-72i_1 [Eyi_ELtaz
5
LG+EILuf TLQ)
If addilional space Is required, use Conllnualion Sheel, Form 15.9,
SUPERVISOR APPROMING SERIAL NO. REPORTING OFFICERTS) SER: Mo. DIV; DETL, PERSON REPORTING (Signalurc)
DATE & TIME:REPRODUCED DIVISION KLERK
4 ,
(Zack_ 10768fete
TRDEXED CHIECKED
6.5412776)
fuz 298
D#Adee"FV F FDant
(La
64 QJ4a
F ~t
PEtk
~u
4_.
WTl
1_
27
==================================================
Page 26
==================================================
SHOTS FIRED CONTNUATION SHEET
Los Angeles Police Department SHOTS FIRED
PAGE Mo. TYPE OF REPORT OKING NUMBER DR No_
ITEM
No. QUAT: PedkerTs EARzI (evlAUce 496134' 6RszL-4ul
SERIAL NUMBERS
iteM # |3 THRou6h | & ReceiUew Fzom SsT, SWitbrT, W; e
- ))426 (64DFcForch), €Gt swimzt 067Aifev (Teus (k koThiNc)
Rreo m CATholi & Fnies
0
FAThee ~JAM € $ Muuoell
(aod, 4936 Couchides (p 53 LAS H ! NGtd P@-F1 #
2268483', Frfhen_ MunbeLl LJA% Xor 3TAcew AT
emtrgen64 @NTTZANc& Td 0oo6 64MAEATh
Iosf WA Le CAri4 | bJ6 ITew &Cc (othinG) Fitter
Munoell HA+ 06t A Nqu ClothinG -Frc-o ni Mres. Kobent
F (en6eoy At CeLsTAL [lec, Hosp kno Ipstructcd
Tu+)6 gorF st66 T GcoD SAMAEATi j) Neap? Iteni $
@rece ivet E67 6101 htit 4T" ATPTeoX 1 80 Fh ,
Itew # I9
rzed
33 RecgWe-l 64 )Fe [Zoacti Arcow € 67 VAri 1(AHa)
#16<32 AT Gopc SAMGATit Hosp (41 Flpoiz) GAfpecf g34
SGt UAfLnes bnl Rc |Tews Gzom: g6ttdacl Horr^1L #SIf
(1nTeLl , Div ) + str 5,mi SCherrzer Oh 87, PLopia
Gvod SA MAR ^Tt
#osp Shtotly #FTee U's A1TcI VAL To
Noep. ((Tevs Lere 2 Brls heets
5 1 6npTy RTL, seizun (osd
Witk IV Nee bLe )
Iteu # 2 3 (VAl #gewoe_Smel) Rec! 64 Drc {zoack Fizoj
DFc R,b, BAEkcs `t |21 02 MTFo biv) bFc E+zrJes hc
Rec eivec iten # 2 3
AT Ceisrrus_ 1661 Hosp AT A6 ,
[SLDo Stvplc 6f VicA Kevnecy)
7
ZTU/ 7 36 , 3ult+7 Flanri~7s Wtfc Ta ft~ Fho"
R,q61 M#s70/'66 A261 " F V 'tT's Htd, #/om 1t/7 ~umcrkus
7*fc zttnf WtRC
feneds l Frvm
7|em+4+7i7
Beve
Fhomrs
p4750/3477 A#wz! Tak+
Room
4y 0k WRTLake, Crcd Saninntan
Jo7" 02 Vsrw
2028] ,FkorA 0k, Wttert
IvT0
(usttdy 6y
AAmpcr 377M A~8 ~44
Tc ZTewf (enc 77/k 76
Vbc/0 77M8 2;7
A$ fVadte t ,
ph7os #F 7 IDomJ
Front 72 /1osp+7
0 h07dnfih*x , 6anJcS Qkser
7o Rtn/bel _
ETeim > J7 Rc tcvel Ffrm 2/ Wartlake 4777.00 #m, 'y +7
tcoue Takcs 70 RanvarT ~JnJ
fc94 Af F6nsc~f
897"
iafnr
7K167 6r
704
Foim 15.9 (Rev- July '65) CONTINUATION SHEET
Co
~To
64
0f
1240
Anf
==================================================
Page 27
==================================================
H -
JY iLL UcPa Cmetk OME Found Found FiRze D
PROPERTY KrEPORT Type ONLY Evidencc Evidcnce rty Safckccping'
P1ez-52L466
RESIDENCE ^DDRESS PERSON PRIPER)Y BOOKED To (last-7ir_ Addle) RES. PHONE BUS . PITONE
Deur 1.
lxr
1
QE3 3oiJN
RESIDERCE ADDRESS ARRESTEE $ ARE CHARGE BKG, NO.
2__ (( 21Z [475739
.SIDENCE AUDRESS ViCTIM OR OWiER" S NATHE RES. PHONE BUS Piione
3. 30LAARAST Ni MJL Gxi, 3.
CLAYTNSEeCAE Kcs 4511//22
L
RESIDENCE ADORESS PErSor REPORTING To POLICE DEPT (Last , Hiddle) RES. PIIONE BUS , PHONE
11 ( (
I_ 4_
DATE & TIME TMS REPORT PROP. BKD ^r INV. DIV DATE & TIMS PROPERTY TAKEN INto POLTCE CUSTODY LOCATION CITY OR REPORTING DIST.
G-EGZ
'% QAm? 2Am (.2' 12 43400 442 {ILSeE 2SL
TYPE OF PREMISES TYPE OF PROPERTY DIV. RPTG. Evidencc; Book To ARRESTEE: IF NONE, Book T0 VICTIM_
Found Evidencc: Book To OFFICER IF NO ARRESTEE OR ViCTIM.
Hiz Plps1NLAILE AaAl
Found Property: Book To ACTUAL FInDER; DIV_ OR cIty & DATE CPIME OCCURRED List ANY CONNECTiNG REPORTS BY TYPE & DR:
Safckecping: Bojk To DEPOSITOR, OwNER OR PERSON In LAWFUL QAt)2 L:5 &8 Pe-SQIE 5LE6
POSSESSION.
TS TMIS STOLEN PROPERTY? PROBABLE CRIMAE Prints Pholo S..D. Other (Separatc reports arc rquircd for cach diffcrent
classification of propcrty) YES No UnKNOVN
2ELPL
T1)1F STOLEN TN CitY 0F Zos ANGELES EACH CAST MUST BE COVERED BY' CRITTE AND FOLLOI Up REPORTS 72) DESCRiBE CiRCUNSTANCES RESULTING IN BOOKTNG @F TMTS PROP
ERTY (3) GIVE ADDRESS_ TImE And/or Phone NUMBER BVHERE CONCERNCO PERSON(S) MAY BE ContaCTed BY DAY INVESTIGATORS
TTEM QUAN- IF Not LISTED_ OR other ThAN AbovZ_ (4) ITEMIZE And DESCRIBE ALL PRCPERTY. GIVE ALL SERIAL NUMBERS And OTHER MARKS SERIAL MUMBERCS)
NO_ Tity OF IDENTiFiCAtioN. LIST ONLy ONE ARTICLE On LIME AND ENGRAVING
ffeZf_OeAE_Qofel_Eu_XEZ__
p443440ug2S444,Uhf2_eX_EeZEselzL @li_
sSALeSesLEyz_ZUi2lZ_WE_ez2es
+Sle_dxisss_JzesZs_UZIE_LCZi_Aeee
_EE2E_U1203l MKnCE_Lxs____
Ys_61Leu_ekleu_LSLeNJDLVCA 0_4414_+
HELMNLbuL_S LEiLje_ECEDifS_MKALfI)
~CLACQ~_lad_Zs-LL_Jun_UUEJWEsEx
YDY_L_SBEEel_elf_LYDZI__
JLZEAeLee_hcJzejezfllrer_ob_
+io_42_se!l_WWjl_ck-Bel_sl2x
~Lshe_Wcs_i_ZUlecI-f_LEJUEX_"z=
#beJuJWeci:__uz JE_Fukl_*-Ul4
#ewgWz_yur_er_ALELLIYDLe4
Quz2Az_JL_Jajl_LC_Uur_ JWlckl
DcsKfWrro_
1 DeqehlZf10232 ~eelC_OE
S_Wf
If addilioial spacc is required use Conlinuation Shce}, Form 15.9.
SUPERVISOR APPROVIRG SERIAL No. REPORTING OFFICERCS) SER: Ko: - Div: - DETL, PERSON REPORTING (Signalurc)
Ka)cd (C. /02/2//81 2
DNTE & TMME REPRODUCED DIVISIOM TERK TDEXED CIHECKEU.
Fona: #: #Ftd. 1863) PZCRE R.3rt
3&8
First,
4z2
==================================================
Page 28
==================================================
LV? mciud rUhico Uiparitazns CEcK DRE Fejed Fc323
SVEEZXOZEZDAZ Type QnLy #+ivence 0 Evlyezco ony Sofeltccr:c] Dx 168- 5-lb 66
R;C_ Cr Accjes; TZRSON FZ0PEnTy CNnKED To (Lasi Zh) TES. FironE EU5. T3CZ
c Zeens E Joha F}
TRESTDEECE NDHEES ATESTEES NHTE CIARGE ex7e@.
247ealye5/22
SIOEICE RDDRESS YCTIRTOR OWMERS NAME RES. PKCHE @BS. TRRE
33
Tans:
3
Ken4e2y ReeeT
RESIDETCE ADDRESS PERSON REPORTING To POLICE DEPT. (Lasl, Flrst, Izidale) TES. PHONE BUS. PRONE
4
8NeAss832e Hozel
4
Hans KeezuEE
DATE & TIME THIS REPORT Prc?. DMJ.F IKv: DIV_ DATE & TIRE PROPERTY TAKEN INTo POLICE CUSTODY LOCATION CITY OR REPORTING DST 50 6-S-6 8 3; AM Rat? |oss 6-5-6 & 1 ; 30A.H_ 340 W} 1s8i2e_Bfwo 251
TYPE OF PREMIISES TYPE OF PROPERTY DIV , RPTG. Evidenco: BooX To ARRESTEE: IF KOHE, BOCK To VICTIM:
Found Evidznce: BoOK To OFFICER IF /'o ARRESTEE Qr VICTIH.
HezeL {aPE2 Racde
Fcurd Property: @ook To ACTUAL FINIDER: DJV. OR CITY & VATE CRIME OCCURRCD LIST ANY CONNECTING REPORTS BY TYPE & DR SA;E
Safekecping: Book To DEPOSITOR, OIYMIER OR PERSOH !N} LAWFUL Race 6-5-6 & cere AzrEsT Pear
POSSESSIOM_ TS TMS STULEN PROPEnTYT PROBACLE CRITXE Prints Ptolo S.D: Oeter (Separatc reporks ara rcquired {cr oech diffarcnf
clossification or properry) YES NO UwkNCHM
47 PC,
71) TF STOLEN T! CiTY 0F LoS ARGELES BCh CASE IUST BE COVERED BY CRIEIE AND FOLLOI-UP REPORTS 7z) DIscRIBE CIRCUMSTANCES RESUL TING TM BOOKING 0F TKIS PROP-
ERTY_ (3) GiVE AdzresS TINJE A;id/OR PHONE Nu;BER IVHERE CONIcERNED PERSON(S) HAY BE COiITACTED @Y DAY INVESTIGATORS
TTE? QUAR" IF NOT LISTED_ O3 OTIIER TMAN AcoVE (4) ITEHIZE AND DESCRIBE ALL PROPERTY_ GIVE ALL SERIAL NUMRBERS ANd OTHER MARKS SERIAL HU:EERiS)
Ko_ TITY OF IDENTIFICATION:" LiST OrLY OFIE ARTICLE 0x ^ LIMIE. AND ENGRAVINiG
~DEs"s_WbiJe_'NLESSZLEZi2 ZHE_Sflee-ns_@E_Pogez3_
Zensy WAs 9Qsj&742 [lexs,Keezmofe W#e_mze2
Tutn;' Eleu__14ze)__eor_WnA_BLve4_2 u_2q-J44_
MEjEA4e24_AEEN _(_Reize_
5
Dp_{SBS#AR94LEE
2lolaeeeeCal}_UbJ_ReikA 2eleetes_72 Jhit7Uz
4E_steey_leekly
2
Mal_Ha-en_Hii)_6elew-4742
134_BA4-71E2_ biEJS Sgea_221ky__Peox_uj4_2_
ece@F_8124_Wufi_EPE4269_2 80_1-Flee _PI_
2_feeI2e44_21_ErBeskeeaZereL_eEct_722K dex_
sin_o5_24y_722202zeEoe_ze Pas&27_Aejecziu_
4uilzee_ Er_hugmes_AQVifeD_BrG_#8_fdobE-E2se117o1e 4
7 Eeo1_22_2E2%ee_4Lstee lg_G-se&_e22_1
UmeKeA_Eoe_E1i9u4A4 JJ&BE-# Rane Jzex_
Bpfee_:_Wlite__Wil_Eleee_Pli_ef_E1e:318o2e_
JbreL_2eng_es_144o4_A_ 2eg_ENL_ 2 &lack
@2:ye2=
~
E426." 2IyrED_i4!EPerAioh fuAtaih
_ElerzioA NISbz
SHIS__EJEeu_
If 3al sp728 Is reqjired_ t2 (pnlzJul? Sh: , Rs 15.9_
59ZVISCR ,Ppramig STTAL To. TEFORTING OFFICERCS) Szr @o. - DIV: DSTL PEESOI EPORIING (Sialera
TB.1845 10599 (ant
CATE 6Tic2 TEpRoDuCeD DJVI5iOA} ICE ED GZGiZC
6.648 I3f 2X2
Fcsm Zi.l iRc Ft&. 19i3) PzcPERTY Repje?
D:g
24
2E
Peee
==================================================
Page 29
==================================================
Los Angeles Police Departmant ChcX ONE F33ny
PROPERTY RE?ORT TyPz @mLy Exld-ncr Evidanee Prozwiiy Q Safoteoping DR {zz H6
TESIDENCE ADDKESS TERSoj P ZPERTY DCaKED Tu (List- i3 c) RES, ( OnG @PhoNE
We 60 HeRmER Sk
13
Hsan
53735 L7972
RESIDENCE AOpRESS AREtS ZE $ F CMIARGE DKG. Ro.
2
~Tet Doe_ 2LZPely9s_/39
AESIDENCE ADDRKSS victizi OR OwMERS MARAE CBePHole 2)ePnone
3.
SteokL IRLu WEAL 53735 L2127
RESIDER;CE ADDRESS PERSOR Repunting TQPOLICE DEPT. (Lzst , Lllddhc) RES, PHONE TuS. PHONE
4_ 4_
DAL_ Tetlz 6x16 MA4s2Ukxt 2534
DATE & TIHE TMIS REPORT PRQP_ DKD, A TIV , DIV , DATE & JIME PROPERTY TAKEN INTO POLICE CUSTODY . LOCATIOTI CITY OR REPORTIRG DIST
6.5lx_ 5@n Delsleshn} 3
7nl5425 S4z_Viuceste_ 23Z
Evidenca: TYPE 0f PREMISES TypE Of PROPERTY DJ. KTG, BODK 70 ARRESTEE: IF NONE, BOOK To VICTIHA,
Found Evidance: book To OFFICER IF Ilo ARRESTEE OR VICTIM.
Hospiza ExpEHDED
Ulat
HD
Found Property: BoOk To ACTUAL FIIIDER_ DIV: OR CLY 6 DATE CRIME OcCuRRED LIST Any CONMEcTiNG REPORTS BY TYPE & DF
Szfekccping: BOOK to DEPOSIToh, OINER On PERSON IN LAIYFUL RAxLn 2-S.68 ARREst
- CRimE
Possession. TS ThIS SOLEM PROPERTTT PROBABLE CRIRAE Prlnts Prolo SD, Olh:c (Scparate reports aro requircd for cach differeaf
classificatiori of Propar} YES Ko uhk*ioii 17 Pc;
TI) TF STOLEN IN city 0f LoS ANGELES EACH CASE HiST BE COVERED BY CRTME AND FOLLOR-Up REFORTS_ 72) SE-CeIEE CIRCUMSTANCES RESULTING IN BOOKING 0F THTS PROP-
ERtY_ (3) Give AddRESS Time Aiid/or PhONE HUMBER WHERE CONcErnED PERSORi(S) MAY @F CONTACTED BY DAY INVESTIGATORS
TTEM QUAN: IF Not LISTED OR OTFER TRiAn Above_ (4) ITEMIZE AND DESCRIBE ALL PROPERTY_ GiVE ALL SERIAL MWiMBERS ANO OTHER KIARKS TERIAL TUEIBERS)
10 _ TITY OF IDExTIFICATION; List crily OME ARTiCLE 0wi ^ Lime Aflb EHGRA ViNG
We L W Va L JE_BELeuz DEseRiBEn_Ey_EDCE_Us_JRE MQUED_ERex the
LEEtLewER_ze_Ibe_BuLkEL_WAs_LoREEL _ w_bA Letzee=
AsqEct_BE thE_ZeEt_EiLA-ITt Wl s_EnQLED _
L
thE_ MiDuny_Hesoit4ly-5EAS_Sp4-Vivceute J4's_
CsZEN_ AnL feleeez_At_32Z4m_6:S:62
3ziLefzExpeurel__Qossjake_ 22_eal_
S
EIDE WeE_alel_MaplE2 _ Eez-=D_Duetzo_
022
SHApe__Bat_TAef2 _
~
LL_QEA_Zmbols AlefeRpak_
If additicral gpze is required, use Carlinualion Shael, Form 15.9
SUPERVTSOR APPoviNG SERMl Ho RERORTIFG OFFTCERIS) SER. Ro: DIY: - DETL. PERSON nEPORTING (Signature)
257+
Jav Rf, Kfzee #6216 H.D),
X
DATE & TIMTE REPRRVEI 03TZERK IMPEXED CRE%:@
6 S?/
E. Keanokx' # 10498 H;D.
302
Fourid
89
Flrst,
RBegp @.2
AZ
Ll_BX
==================================================
Page 30
==================================================
Los Angeles Folice Dcpartmcnt ChcCX O#E Fcwnd Foutd
PROPERTY REPORT TYPE ONLY Eridemce Evidencc crty Safckceping DR
4 682<2L4e6_
RESIDERCE ADDRESS PERSJ PROPERTY BOOKED 70 (La;l-1 ciddla) RES. PHONE BUS. PHONE
19 1
Des Ohu
RESIDENCE ADDRESS _ ARRESTEES NAME CHARGE BXG. NO.
2. 1a 2LL?c Ha543
SIDENCE ADDRESS VICTIR Or QwrE'S MAME RES. PKONE BUS FRONE
3. 686 E ow@LD 3 Etik 544N 793203 ~03R
RESIDENCE ADDRESS PERSON REPORTING To POLICE DEPT: (Last, First, Middie) RES. PHOME BUS. PTIONE
'AEreLiocm2
4_ 8
DATE & TIMTE TMIS REPORT PROP. BKD. AT Nv. DIV_ DATE & TINE PROPERTY TAKEN INTC POLICE CUSTODY LOCATION CITY OR REPORTING DIST .
39 268 28M Kalle 7N
k6s62
W Al 2 Houke5 444244
Evidcnce: BOOK To ARRESTEE: IF NOXE, BOOK TO ViCTIM. TYPE (F PREWISES TYPE OF PROPERTY DIV. PPTG.
Found Exiderce: Booi To OFFICEP IF No ARRESTEE OR VICTIM.
ResL2re @2215
l
Nzra _Bezks_ Zav
Found Property: Book To ACTUAL FiNDER DiyA OR CITY & DATZ CRIME QCCWRRED LIST ANY CONINECTING REPORTS BY TYPE & DR
Safckecping; Book To DEPOSITOR, OWNER OR PERSON JN LAWFUL IA1e 2_-3 c3 EvD -24278-222 Dgv_P_
POSSESSION_ TS ThIS STOLERI PROPERTY? PRCBABLE CRIME Prints Pholo SID: - Othcr (Separate reports arc required for cack differcnt
classification of propery} YES No UNKNOWN 242ZC
71) TF STOLEN Tn CITY 0F ToS AWGELES EAcH CASE Must BE COVERED BY CRTRE ANo Fozow-Up REPORTS 72) DESCRTBE CIRCUTASTANCES RESULTING IN BOOKTNG OF TMIS PROP
ERTY _ (3) GIVE ADDRESS TIME ANd/oR Phio;E MUMRER WMERE COMCERNED PERSOM(S) MAY BE CONTACTED FY DAY INVESTIGATORS
TTEM QUAT- JF NoT LISTED 0r OTHER ThaN Ab0vE_ (4) ITEmiZZ ARD DESCRIEE ALL PROPERTY GIVE ALL SERIAL NUMBERS AND OTHER MARKS SERIAL MUMBERCS)
NO. TITY OF IDENTIELCATIOII iist OmLY OME ARTICLE 0f 4 LINE_ AND ENGRAVING
EZ_TuVjjs- 9f
Pzio_Iil_RurIs
L
3eterJJSzel
Ltezi 187-9"E0__EC
2ezyi ZiG_ Aree_E2_SRxt-_5J2#ti
if AN 517r53?
27e3-5
71+F
bu_3e4D fz 2
slzx_LSaz
@_m2ss4 J304_Fev2eJbefes
1z Y__AL_D__veis_eriL_
D ZnsereEi_Se-Lese _3@_skeets_
@Esea 209_702s
Zez_
~
SSewe_Zy
Ser_Ze-_E@er__n_IE_20_A_Dleee_
SAbel RUtzee_Bizlt
7vy" 0 I3_22zs ExIAZ HEAz>bELtae
SZate %r_Ls
hloj?3208_= 322 EPLEZ_ _ LUEe BesnD
AR2Eex_3"4_S"E__Cmze~Wkblstu-S_S
Ze"er_Z zelre_PE:2:2S_ _B _3
J28x18 Se_f7V0
" L-ExLe.28 ""I"_=___Jzns-ex2ezy
~m-erinc_%__ ffeI ~u_L
T27 DLs3Vs_[2-I 2Enmi
SaI 32-4_07%232
If addi'iona}- space is xequircd_ iise Conlin-ziion Staeet, Fem 156.
SUPERVISOR APPROVING SERIAC %6. REPORTING OFFTCER TST - SZR; Ao. Div,ZJETL_ PERSOR REPORTING (Signalure)
24w9T (orp#
DATE & TiKE REPRODJCED DIViS? IRDEED CIFCKED
2541
Fenz 20.1 {RzTeh 13 PRQPERty RElorT
(2i)
or+
7Eb+
pe=
4S
#[oeey
Lexo
Lobgx?
==================================================
Page 31
==================================================
Los Angeles Police Department CONTINUA TION SHEET
PAGE Wo. TYPE 0F REFORT BooKinG Mo DR NO:
Item
No. QUAn;
425__3 s Li-S2Lyae_
SERIAL NUHIEERS
S5fJe_Idets
Lot 7l
~Pltejes_ 2 Itih Sifltz_
Ttc-
Zene-ie F12ezv_ Zepreen bart_B3
SeZ_Z42X 72225__4
1p_ifel-
34_3120 340 ktztf
4escs
22-TppsA
~X
Ce_eP
Zl
L_
Cno2G 32_
_sar_Zbl
s11_ 7 439 1
34 OJuU UcK U1ot Olntr Drit WCOC CFnetd
E44z
S1es3 Al 43 eeyeel_
ax
++ Czrltd0_ZY Ssifl-iUs 2426_344
[5+Zy
5tlf4 Chizea CLessz_
Da-spopz
Fo-~ JDfxhe400 4S61_ Lehyhe€ 22
04tA
IenN
CELEcto
TrrlL, brnRWLten
4_SETeis FezNR Ixof
#X=
ElJL 42+le
L 37)
FeRzPI_
+_STAIn_ Cex feR@s '12ltA2etr
SfXiti_ Eibb-
Diiz LEZT cx
Juns 29_
33
84_NLXsl 132t
12-80 $440 Je _ ~EBL_EEesLL Asw+5_
SZ+iena TZicH&ibs42_ 8gs8xTLA 3
++21 E_
DX
~ez_3PM_2X6_L1E IZe_P_
4 F4i+Zu
IRU6E _s_2ZFp_ 3443 _ Coze_
IhT
Cesesk12y_
Bvekbt_ _0_02 @
0n 3425
Ll
EpyeP_1n_ Bs22eEBes Debvevs
8t _B_Zet _ZeewDI_
lex?
56LF 3==
+
2204
DulL-er 12 A-rAGE_ CerlsE-biEQ_ Fe224_
Fl (zmncs ha*' Ze-e_B~StE,_Usyf 243S
~ St O 4
YLLET
Szic-ntIs Feune
U
9X
L1nfes_+
42328R_eret_Bx_Ssj_Z_Le _ 2434
W
CdrIllD:r
"ZASESf-3ZS1z0_022E3255
FilD_24 Sar6& [lonf 2ENak Z_
Z_ E I'els 72 7436_
orm 15.9 (fsv, July '65) CONTINVATION SKEET
21
4+
Enot cen= C7"
37 _
#e*_
42_ 46q5
{
3841
D
==================================================
Page 32
==================================================
Los Angeles Police Department CONTINUATION SHEET
PAGE TO. TYPE 0F REPORT BOOKING No. DR No.
Zrm
NO. QUAN: ELLIZ_
4354132 [2s-S2LLG C
SERIAL WUMBERS 44-Bus
'k6eS
Ces 0Y2_E_sera__kettiz
(11_/ EeulEuzS4e02
5
Eezrd_J1 7rlort
_Deeesulo_ _Za3Li Zeever _ 3x_Zo-_ Blryo-22]
I
F_
ZESFa
G_4Ceedg_ arekes
@IAJN 6 ~9__7_-222 Sn Ziemre-ftz
J2-0Lsrer 2ee:s2
TAa
2743
Demirn_=Bx fs_Blerer
~ILZ Lld {ZD7= 6= Tiad 0rs
"2 LSe* ~epfes_ _liil 2 @DE<Z
DrtLo
22-szc' _
Aury
22z RgsflD_
F
3l+1 Pfyes
C=9
N 6 TLe
~_
221Eeee-
Joe
CrL= 12=> CI
CD5s OFS JkuszR?_ LTsls e3tersd O_ QECerz
+_eaozus_Jesbitns_
9
=J22
PensEses Si_assie&
+-x_Li_L_E_Iine% 234_
~
Set 4e_
7603+f2"n4i]
JTEM$ 4E% 2 7 em0U
DZZ
#L Ert Ite_b44_2_
Tt +JELLI-feth
Fuds_
EllA=
3L_2_er_epiNBv2 HpvbBq
t _ki_bfeJe_tp_Pfeel&INC_Em 2s_}E4n
FIe
E+lezozLe_L _ ieselie
QRAE
41eX
Ss__Ruzez
Efeell-rs
305
Foiti 15.9 (Itev, July '65) TONTINUATION SHEET
3ln6 Hny
+-J+es5
==================================================
Page 33
==================================================
Lus Argeles kcice !cparlinei :ick Chie 70z Fcumd
PRopemty RZpoft {FZ "iY Eviecoce
[riience Pr2erty [i Salekceyics " Dp_ '6I621486
TSTEcE TJNRESS Fziz, FREPERTY EwREV -f R2S: saime @uS. FXCRE
1_ iWi 1.
TS1Q4AN ZU44nA UAv: Uk
RESIDERICE ADDFESS 76eens# {PARGE EKG No.
217.0 2 '7/37
S1C ZfIcE ;Czp Bo RE,7RR PuS. Pijowe
3_
RESTDETCE RDjEzzs FIICecEPT.TLSFr3) {7-FKZEE ElS, PHCSE
1_
inG 0FfVekve,
DATE & TIRKE This REpogt PRCP. 8*D. !! ij Div: FRoFERt? Tp%EyinTU toliCz CiStocy -Toc;TWon-iit? CP REP KTISC DLST.
6 Yv
24
EEE#Nwbee 2S-L_
Evidencc: Ejjk To ARRESTEE. 1,.3;5 Ty?z Of PRJFESTY Cv. RPT,
Found Evidenae: GSXT tfrui; # {RRESTEEc5 Mctem WVo D932S1k_ KlmSE _
Found Proper'y: E3Gk T0ACu:tek {C??Ed L!ST # (eThG REFORTS Zy Ty?e & D?_
Sofckccpirg: Eo,r 10 DEPcs(Tg?, J '.ER $: FE630. M lowfll 48 LersZlzselIb
POSSESSIG: 37 R JFERTTR YfjskELE CR;E P: mls Ptcla SD: Oter (Scpara:c scpots Jre icquired {or c2c; -ifercn}
classifizarior: cf Pcpcfty) 8) e;kid"i:
() Tf SToL.ER T#, Cif0F LZ;A EES7 3" IstTjs; S2 zovckeg 70.16DRnsRTs "72) TESci;zm CIRcVYSTA"ES RES ILTiG TW ECokr;G 0F TFiS PROP-
FRT (3) Gi": 233:sS 8 4'r?u: E C3 {eo E0 ?f :**S} MAY ZC;TACEDEY D4Y BBVEST SRTOS
TTETA QuAR- iF (6 Lesif} ;: ASwE (W ij {ZE #On cRcAL P,j?f?ir_ 34:'E ALL SerIK[ FUGES 6J OT,ER MARKS SERIAL TUZERIS)
1O. TITY 0f :D= d" C 0xe AEI Axi EeRKiG
iL 0LVil A_JIe_Ck_
2 Dr: Luk Zudogilflieg2-LLED_
622_ @Lk NwwlU_belee_AU_Just_uTi
WL_Eie_LV2 '4 beFYfyEd_ BELW_ewI
exeeb_Elgm rnarenr
J1m1 mdnw 0247
Hel E1eni 2
ee5_ QJulle?
'E@Wen_Weh TizWeri
~e_B_WBeve_ 874
LAUABfL LY eblesol_
IUi @e4lel Xe
L
JWefii
3 5t7, CArP_- Lesbo_Tck
4iewee 20 2424S
{ 0rd
i: $ Feu ut 0
mleey
Jf & Iditiczal s7y8 is %31c4 Stxt_ i63.:5;
SuPErviso FPFRCTBG pe7so; ?E
dA7E & Tixe RE?rCOUCED-9ih A.eee)
Forin Ja_l (iFro 39690 30x
9080
'Jin
Qf
~
==================================================
Page 34
==================================================
Los Anc:las Pollco Depoririet XEcX C.? Po::]
propenty REPORT TypE 0{ly
Ki %vidcnce
Exiecaco op8ittyy Sarcocclrg Y6b
Resjori;cZ AOEZZSS FLTCO, TroFenTY EJTXED 10 (Luu?-3irt-Dizio) HET83 3727
1.
~owa2
St; TsDena
1.
Sihan_ Zuehal_Zistlare UAJ UNI
RESIDEICE ACD iESS APRESTEES RUETE CAT; Z L.{E /sj
01 _ 2. 11
187 Rc. 145/37
SIDENCE AODRESS ViCTI] On CHTTERS NANNE PES: PXONIE TC3. FRCHE
3 33 KenNesu 'Robet
F
RESTDERCE ADDRESS PETSON REPORTING
7o O1cE DEPT, (LaL, Firsl, EiaJle)
RES. PHOHE CUS: EvT77
4_
RzeoRtig QEELCer Wi4s2u
DATE & TIRIE THIS REPORT Prc?_ DKD_ 41" IHV . DIV DATE & TIME PROPERTY TAKEII TTo FOLICE CUSTODY LOcATIO4 CITY 03 nEPORTi; Dist.
6-6 68
"Iham}
'Rmc 6-6.68 3dd4m 622-Saagutan Inse 249
Evidcaco: DoOk To ARCESTEE IF NONE, ECok To ViCTIk. TYPE OF PRZNISES TYPE OF PROPERTY DIV . T7tG
Found Evidcmcc: Boox Tc OFFICER [F NO RRRESTEE OR VICTIM;
Hose_Molque Buller (Nbzes
A.12
Found Property: DooK To ACTUXL FINDER DIV,OR CITY & DATE CRIXIE OCCURRED LIST ANY CONNECTING REPORTS BY TYFE G DR Rv
Safckceping: BoOk To DEPOSITOR, O:YNER OR PERSON IM LAWFUL KAme 6-5-68. Cuss Aesz_Aemrh
22-
POSSESSION.
TS MHIS STOLBI PROPERTY? PRORDLE CRl;JE Prials Ftlo S.B: Quzr (Separata reporis 2r0 Fequitred for cach dikkercnk
classifica:ion of property) YES Ko unkinH:} Nhucz
Ti) IF STOLEM Tn CITY 0F Los ARGELES ECM CASE kiuST DE COVERED #Y CRITE ARD FOLLOWI-UP RePORTS_ 72) DESCRTDE CIRCURISTANICES MESULTINIG In COJrITG 0F THIS PRO?:
ERTY_ () GIVE ADDRESS TIEE Atid/or PHONE TUMBER IHECE COIcERNED PERSOH(S) MAY BE CONTACTED BY DAY [NVESTIGATORS
TTER CUAH- IF Kot oR Otifen ThANi ABovE (1) ITE:IZE AND DESCRIBE ALL PROPERTY_ GIVE ALL SERIAL NUMBERS AMD OTHIER HARKS SERAL MD. 3ERS)
No_ TITY OF
4OE,HiSJERFi3,
LIST ONLY OIE ARTICLE 0H A LIIE_ AFD ERGRAVING
Zzen <e_TAKen JATe Relee (u_toly_ 21.4;_-68
{e:' C0_ Zn Evm_Fbe _etk AI_22 dabas54mz
Ze_
JbyLECiughes
7'
Rame_Qezs_Zzz_ ~P@Nsz_2F-4-h2425
N
JTEL_exzel _ 72 Zbhe_ZEBented_
72oi 2_Ulalp
L_5
Cosso~_-
1
@h_Lezze4_WAL(EZEC _FZe_EbozeL_DesiSUbDZETTED
To The Degease2_ _ Zvem # _53 WAs Removez
3eoo--zhre
6_1__CeueL_Jegzbeae_(Azsze)_Oe The_2EeEee)_QuRiNg_
The_ UJQ ~z_ @poo_samaetran sbsptznl_ 47zre
# S3_ WAI dZEn_N2 Bnee_Custepy_sa_3oz
aeicerez
I _
# 7167_Rame_ZEzs__uhc WUA_"ereni-i Tbe _347
L
Ezz
Jeepqd_ Tss_Ztem 233_E ez wheh_Zp2_EZ
Wac TAEe _tA_CLSTody_ky_
'Zezce
F
7222 2eze
is_&bvzZen "SIuus_RemevenY2er_ Zhe_Yizezesc Jeb_
JQg
[emeles
# [26s7_AI_De_Une_Jeh_ 4l45__Zm2_ VezzeIf
31s BI_ Ez_7725 # Se:EY 23 4Zoz@ve Ze
NoruFLEL_62e_C0o22216o4 Q2_Zzex +83
Wzh GuN 0f Rzsszee
~ S = R ~7+ T= K
53 LSzrc2_% ENvelee_blheh L_MDZE{ez_ Sel47dz
Len:Je 0A2I-sp Ene_2_
53_
43lugz32el lN?Iack1ee Cb2ode?_ @jeE6f-s.3L
54 KtezuN #21f3889
Jt ~cilical srzce Is requlred, E: Conlinuxlicj Steel, Fr;7n1 15.9_
SUPE,VESOR APPROMITG SERIAL T REFOzTIN; OFFEZRS) - S6a FO: DJV- PEiSU;] REFURT25e Ejlnx
CTClaL_k 35
DATe & M.e RENROCUCED E3:ICH CEFU [33W 74ZASA2:
{l0
72-/an
Vcs7 7 7 9 iFm8 0 trtob 1aaRj?;Ty Dfrant
13J
D76g_32/
Cq
'Ripe
InF21
#52
2S ,
esy'
@ame-
3uz32
Z4'
/ete #53_ Ttgn
Lg
Z_
ENvlet _ LMe_
2 L ~
Ujs
U
==================================================
Page 35
==================================================
lca Angoleo Pollca Osparmante CXECK 0NW Tcesz
PfOPERTY REPORT TTpe O;.Ly ZEvidcsse Lviz"J270 cariy D Safokcoping 03 6k-S2/-4/ob
3573F4T:OREss PzzEui PROPERTY Evnx_) 7) 1 SYINt-TIz3I) RBS; Mo e LL3,iuc
(2 6 KbuAcss { EaSDena_ 1.
SieHer_SlHAd BLs HAsb UNks
533TDRESS RRRESTEES MRME CHAFGE Bx312.
2. Lk2 Ps 42739
S1d2cE ADOnESS MCTH OR 3 MamaE RE, PHOME CuS. N;c;e
8, 3.
KRNNA AYoe abeat
RESIDENCE TDDRESS PERSOM REPORTING POLICE DEPT. (Last, Firzl, Wfaalc) RES. PHONE BUS. PXOFIE
4 4_
Pelss
Date & TIE THIS REPORT PCOP. BXD. AT TNV . DIV . DATE & TIAE PROPERTY TAKEN INTO POLICE CUSTODY LOcATZON CiTY OR REPORTIRG DIST. 1S
Lk-6X_ 12 lp
E
Betlle_k-bx II 25/LLo50
Mntccto_ D L443
TYPE OF PRERISES TYPE 0F PROPERTY DI . FPTG. Evldonce: BCok To ARRESTEE; IF NONE, BoOK TO VICTIKI;
Found Exldocnco: Book To OFFCEr JF No ARRESTEE OR VICTIM.
RankstAILOJ Rzcoe PJS TApx HeK
Found Property: Book TO ACTUAL FIHDER: DIv. OR City & DATE CRIKE OCCURREQ UST Any CONNECTING REPORTS DY TYPE & DR:
Sakckcoping: Book To DEPOSITOR, OWNER Or PERSON Il LAWIFUL 440 7 63S-zf 2
MA
Celme _: Ael:Akvs D2 POSSESSION.
Is THIS STOLER PROPERTYI PROBABLE CRIMJE PrInts Pholo SID: - Ctrr (Scpzrafo rcponts 2ro requircd for cach difSarcnt
classificatian of propcrty) YES No UNkNGHM 4
(1) TP 5TELEM MM CiTY 0F (os ANGELES EACH @SE MusT BE COVERED BY CRIME AMD FOLLOI-UP REPORTS_ (2) DESC Z1HE CIRCUMSTANCES RESULTING M BOOKIG QF THIS PROp-
ERTY_ (3) Give AddPzsS_ TIME Aiid/or Phoiie Humber WYHERE CONCERNED PERSON(S) HAY BE COMTRCTEd BY DAY [NVESTIGATORS
TTEM QUAM: IF Not LISTED, OR OTHZR TIAN AbovE (4) ITEMIZE AHD DESCRIEE ALL PROPERTY. GIVE ALL SERIAL MUMBERS AHD OTHER MARKS SEMAL HUMRERS)
Hio. TITY Of IDEMITIFICATION_ LIST 0'ILY ONE ARTICLE ON A LIME. AND ENGRA VI G
iz2eco85
LYG__EBEE__CoA_AiN_Ns_OeijnAL
SoLUDJRACsi_Of_ElenTs__SRLILLNDLLS__
Robed_KedNby(~LLTL_SNACUNS_ ~Ar_ZHE
~YJATE_Iioiey-bAcATLp)QE_TVA_LAcinecTs_
As_Recnebea_BY_IyC__West__TAEEDAf_
MeAssaAoA__Aqtel__ElGAssY_
ABbje_EM_Recleve 2_Eeom_-ik--AeakRc
WLLAAX_UeS_CAEA _ANDREA_Wesfs
~Rapi__CeaDLAste&;LLNI_WAS_Peeseat__
8_ReseaNsfBL;__EQe_CHe_CnIeNi_
QE_
JAPe_
S__ S W= L C~ S T_TTeM_SAKcD_ZALTI__CusZaky_eZ_2ZSJa
DA_@Beve_DaIe_ITer_MRK_A_hAJLE
L*_SEc_Jo20q:LAPD_Foe_=.-
L 5 L M +n_Wzst ~kY_e__eechs_s_2IE_2e32 _
~yCeulueneq__RLUb__Nallywaal =_Phae_'LleL
~QeKe_QsD_xts St 'De_bA:_Fhx- 22S4Lb _
i #'Jllcnal :uA Is rgulfed, lje ConlIrgallon St L, Form1 15.9_
S97Enas0R PR9VUIG SERAAL m RepoRTING OFFICERLS) SER: NO. - DIV. DSTL _ PERSOH REPORTIIG (Slgnalure) (7:Nez
Kipk NAecdX
Mie VIBE RERQDUCED DIVISIOX ERX
c (el (o-a& 5//253
TDEXED TRZTKED 2222)
16
648211-1022a
'74
Reac?
*30
&8E_t
==================================================
Page 36
==================================================
Li An;gelcs policc Ucpartmert CiECK ONE Gaiind
PROPERTY REPORT TY?E OMLY Evidence D Evidence crty Safckecping DR SHpEc Z8-S2L-ee
'RRESIC YCE DD5RCSS PERSON PRCPERTY BOOKED T0 izusl-Tirst- Mecule) RES. PIIONZ BUS. PHIOFXE
1 (_ 422c4)Cobzi
RESIDEN:E Adi;tss ArrEstee BKG; NO.
2
SIDENCE ADDXFSS VicTim 8R 6# ciS NAME RzS. PFIONE BUS. PHONE
3_ 3
RESIDEMCE ADDRESS PersON REFORTiNG To POLICE DEPT. (Lasl, Middle} RES . PKONE Bus. PHONE
0
CoRHA6_ALE 4. @pld5 ez 0-
DATE & TIME TKIS REPORT PROP. CKD. ^T INV . DIV_ Dii 3 "ME F Tcu?Ekiy TAKEXKNTO POLICE CUSTODY LOCATION CIT OR REPORTIRG DIST.
(2- 7
2211 12 KENm E.beF . 2 %7, LUACeciss Au# 873
Evidcncc: BOOK To ARRESTEE IF NONE, Book To VICTIM. TYPE OF PREMISES TYPE OF PROPERTY Dl ,. RPTG.
Found Evidence: BOOK To CFFICER IF NO ARRESTEE OR VICTIM: 4Xl EL GLeHuine Adyuidz
Fourd Property: Book TO ACTUAL FINDER: DIV . OR CITY & DATE CRIHE OCCURRED LIST ANY CONNECTING REPORTS BY TYPE & DR
Safckceping:_ BOOK TO DEPOSITOR, OWNER OR PERSON IN LAWFUL 1 /k
POSSESSION
2e4rh-_62E2L466
IS THIS STOLEN PROPERTY? PROBABLE CRIME Prints Phato S.D: Clhcr (Scparate rcporis are required for cach differcnt
classificationl of property) YES No UNKNOWN
(1) TF STOLEN IN CITY 0F Los ANGELES EACH CASE MuST BE COVERED GY CRIME AND FOLLOW-WP REPORTS T2) DESCRIBE CIRCUMSTANCES RESULTING IM BOOKING 0F THIS PROp-
ERTY_ (3) GIVE ADORESS TIME ANDZOR PHONE MUMBER WHERE CONCERNED PERSON(S) MAY BE CONTACTED EY DAY INVESTIGAToRS
ITEM QUAN- IF Not LISTED, OR OTKER THAN ABOVE (A) ITEMIZE AND DESCRIBE ALL PROPERTY GIVE ALL SEKIAL NUMBERS AND OTHER MARKS SERTAZ NUMBERS)
NO_ TITY OF IDENTIFICATION_ LIST ONLY ONE ARTICLE ON A LINE: AND EXGRAVING
58 2_|SMles_QLLCAEBy_S22_28_S
kaLu-Zxesz__Lndues-JeiL__BLkWleds_WfErio_
Ebnwz
JAEAx_lnbhja_RLel__Zea_C) _
S W
Cofmxlc_=Buf_ZEZS_ER2LEgffE Qzga2 albua82
~fe-pudeo Lp_SLE_CsLf;_WU_Eesek_Cnuls
BeLLAe_BAG_Lbaxebuae_(_32EAy;
14
LEFEBsshc
EeglBauds _-Eluu_AE-AjWuf_Axn Su:bLntf;|
FiecKLAse-ZllJARRidaf;_EAel_BaB_Pisls _ BL
Hni_akrt-CAES-L_eek__
S=
63 1+32e
7
Wols8Le" Mff_SDS_Ixe
2
Ly
LyBaaties_"aRadse_msin"tEdE_Sles_hseak_I_
#
H-Leess_Kalas
7
flre_?_Sey_ul_Dazs
L_Btiiin "2LAELc_" _abe_Sucmssuim
1> LysLE'+"BA8NI BL_I2Z3L__
# LPL Lfnakoa_ScEfs_SEOaLlEnAe_ _t@J__UK_fLzz
~ V N 7 V Gan L Fl_Sxnles_stf_Epsed_8elt_lzbss_yjAsepbiBiug_
~B2ESAEsZI_Heidzi_BLid_"AIOLITm_ufi_endoic9
L 4i
fALPAEEE_AL& _Wpolul_Baa}s_Ele_Jeet
LIE
4840-_Lossteuts_te_!zf lrin(19LL_CesbG_AU-)AND
HA4LEB
S S Rd
~NeLL4 Bn2s_luese_"icuzl_E24An_QU_'ntellWELJo_ouade
_EQug_ZsfsocaWbeu40c2 _4Ee__AbiEjeL_
IsJEIAC_ALWtor_Abze ffmnrc__ZLEy_d4cie42
~ELIScf-ius_SnLc A,_AElMNB_YES-lesif"Jol2
Jf addilion:[ spacc is required, use Cciilinuaton Sheal, Form 15.9.
SUPEFTTSOR APPROVING SERIAL No. TEPORTIRG QFFTCES(S} - SER. Ti. - DM. DETL. PERSON; RERORTIG (Signalure)
Hua ( Reevs$ 10514 Aus X
DATE & TIMEZACPRODUCED DWVISICN CLEFK IDFXED TMECKED 3fG)RL
0i=?
C, %1 Ccr#it? 10424 Q`
Fom} Jfl (Rsv #cl 70,531 Prorerty RaporT
First,
boL_~
1s+
7r2.
1-E
bLLS
+02
3iey
-Yoe_
+2_
==================================================
Page 37
==================================================
Los Anceles Police Department CONTINUATION SHEET #ons
Fires_
PAGE No, TYPE OF REPORT BOOKING Mo DR No.
ITEKA}
7i0. QUAn; Peorent E2-52Ltel
SERIAL NUMBERS
+-Anp_maesha blzfjeLs_Geesss"E Hegets+ -
4Ensne322-226_4Utle_Erboad_G4bA_Sbej
#zo WEzruAbos_ferLZELisa _uf_Sfe2ide - _
htent F@ikts eKzl Lo 1eie_ Re_
PSDEES
4
Vat Le L ++4_8
202
eJv-"ZEZELT ZEIERZLLTA WVEszEZes__
FHPzoae_WaLk_Exbb_MAepuet_GoL D 2281_Luv
L#StpT_sAA_EfLT ZHE_Zef_AjOUE_Ceulb_Nhye
+Bzz4 heRLL B_ Xsle PWE_+_S2a_
fXLESSIk4-b
Form 15.9 (Rev, July '65} CONTINUATION Sheet
njd;)
J-SAJnAi
==================================================
Page 38
==================================================
Los /inpuies ruiice Uepurimigii PRfSENT OVIHER (La3:, #lddls, Flrm G:E? II bus )
VEHiCLE REPORT S/4nA/v 2 DR 43/45
HBp? |IoLd Fux YEAFI MakE HODEL Dovx TYPE COLOR TYPE 07 REpomt ATu- tarIS
CIiECKEd YES No E41 32507: HnllziNE_ 1
VEHICLE RECORD CLLERK NOTifED TIbe [DENTIFICATIQN NuMBER LICEHSE MURBER STATE YEAR
!0 Ab: {
DATE/TIME REPORTED To P.D. LOCATION OF OCCURRENCE RPTG. DIST.
STOLEN/LOST
DIDCLD27713 TyPE OF PREMISES IGNITIO# DCORS KEYS IN DATE/TINE OF OCCURRENCE DMv VERIFIED BY
LOCKED? LCCXED? VEH.
REASOW FoR IxPoUnD LocATIOw OF OCCURRENCE RPTG. DIST. RECHMPFOUND
1i nr} 17
DISPO. OF VEIIICLE (GAMGE NJAME & LocatiON) Hdiv DATE/TIME OF OCCURRENCE CONDITION OF VEHICLE E{#A3u
X7}& *& f f $ 74 4 74sn STRIPPED DAXAGED
IMvEST: DIV,/UniT NTFD: & PERSOM COHITACTED Recovery/Found DATE RPTD_ STOL/LOST DIV_ STOL/LOST
L7 '16& 2,+3* JEZ Report Only:
CODE: R PERSON REPORTING OCCURRENCE To PoLICE DEPT_ D PERSOH LAST DRIVING VEHLCLE W _ WITNESS
CODE RESIDENCE ADDRESS (Bus_ add. if firm) CITY RES. PHONE BUS. PKOHE & EXT,
Present Owner 5 Named Aboyc E2d Koude) PEdi: VeLP
NAME
JDENMFY SuSPECTKS) BY NO. (Itanic-ad-ress-sex-descenl-agc-hL-WL-hair-eyes-complex.-clolhirg-idtnlifying characlerislics. If arrested, Include bkg: no. & charge )
1
2
(1) IdshTIFY ADDITIONAL SUSPECT(S) _ (2) CIRCUMSTANCES SURROUNDING OCCURREUCE(S). () STQLEN OR LOST: (Describe any access Iith idcnl;_ numkers, aRy property In Item vanlcle "hich could be scld cf pIwned) , (4) RECOVERED FOUND IRIPOUNDED: Specify Iters stripzed from vehicie, Ccscriba damage and all cvicence wlich @ay co;reci Iilh .77
NJ_ olh:z riik 0t cccurtercc.
+ C_
QEC_PZs_A2V_Wbb_ED__lz_ QL_JYE~Eenlee&
+e2eo4 202__80_0_Ensken_Zi-O_A_Ve_#Aj_EXLEEEUE)
tez_ezLess_{_TEA_ILNDA _Tz eLeIfardiMA_fAnr
+e_AeeEeed_EWbXjsasSAo_Led_bLn_6 226+2
+3_NVfszenZen
U=
t__lezren_E__-ZI LEtz_"dlL42_X WLNLEL2- 64S
~Apeon Ip~fecf_fl_zV_e
HacdIllonal_spzce Is requlrcd, use Conlinyation Shecl, Form 15.9
SUPgVISOR ApEraYING SERIAL NQ_ INTERVIEVING OFFICERCS) SER; Ho_ DIV. DETL_ PERSON REPORTING (Sigature)
2E48o_eZX 7_6$7 X 8 Fc
D^TE & File nEPRODUCED DWViSHON CLERK INDEXED ChEcKED 24-2242)z
#y27 4073/
Fars' 3.7_~0_Dec. 1966 VEkICLE RwcrT
Flrel ,
==================================================
Page 39
==================================================
FD-3 02 (Rev, 4-15-64 )
FEDERAL BUREAU OF INVESTIGA TION
1 Date 6/8[68
On June 7
$
1968_
9
SA RICHARD E CROMWELL
obtained the following records from the Pasadena Police
Department
0n6/1/68 at Pagadena California
File
Tps Angeles 56-156
312
by 8A RICHARD L_ CROMWELL
Date dictated
6/8/68
This document contains neither recommendations nor conclusions of the FBI. It is the property of the FBI and ig loaned to
your agency; it and itg contents are not to be distributed outgide your agency.
==================================================
Page 40
==================================================
CRimes AGAINST PERSON EVANS, Elizaboth Y 565.999
FrEPox
P7
42-712-26
257 Frlo '21*
Wcaflnj 0f forco Uxa (Detib:) Locaiion
4mbas g uaor FoEol c Xurd
PesaLble_IveruJolinBon_-22 IOO_ Trilohir-8ladas383.Angcles -b
SPs:
2
Do Ocqurca" T.c Retliv} o P caliper rovolver , U shot %
rm
TEJ 'L 8c665 A:A Appi OfLmAloly&
Dcs_QD:
;;;
25.
A
Lexrtc (niju:ics (Gun Shof Stali, etc,} Trpe of Pfopety Tol.en (Minjy Jcwclry) Valy: &f L;#
Gun Shot WA
Tyc:: 0/ L?0lion {Hlonw Bank, ctc.) Hoto
Condilion of Viciim (HBD, Caop, clc ) Coroncr Name crd Case No. Appaienl Moll,9
Listed 4 3 Good
0
62'
+iclim , Location if Hospitol 0i "siwjry Physlcal E. ickcncc bY (Inv } . Xui?"
Hun & ton_Hozpk_al_
Tioyc Niork ct Suxcct; (Aci i,nj Convcisz;ions) Vchicla U:o 'y Suects (Ycar #ako Bod Txpe Color liconst cn L.t N:
Apparently_fired_&_shets__et In'loln
0
_if fny A Senator ROBERT F KENNEDY locction Wiieta Vicfirn Con B0 Conlocied b'; Irv, |{ No Prone Indiralcd
0d Une_hullaf-struck_RS_.-KVANS_
Victini'$ Occepulon 86832 # Ess plec Bsai= Ad }:ess Cin} Pileria GEcui'
81 t8 Road 8
Self tmployed (printing)
2
365.3132
Stcorid Victim' $ Ocuipation
Person Rcportin Ollerso
TTI 30"Tr-30 -38) Unknow T02 Co5gE2 22 trer
CUBA_
9
St G MaD= Pageden9 796 0 51
Dr. Vio Treafcd Victim "Unkn0w) 65 Kedismn
XJcn
RAV ZLJ , Celso Pasadena 796-2.+6
'if Clrizen Arrcsf Arrcsted by
Witneises Name Scx Raco Aga
Suspecb Nome :Lost Fiosf 1id:ile, A.fdrces, 3 Raco B joking Ct.arot ond No_ Nc Bookcs Kt, Wt. Hoir Cmph_ Other
1 M/W 23-25. N e Fe D. In CUSTODY LedoP I)
Loss {mie Lass {Ona Aricle 10 Iina List urd Fescri: & Fuxy Scrial Nuners onj Valjes in Columns} Sericl
Itom Idcn"im Aduiticnal Suspccts (J; Reeonsfruct Ihg Crire iNo Du; Ilcaticn of Prior iromized l:formatian) Num::crs
No. Swrrarize Oficr Defoils Rclating t0 ths Crime
(3 ) At_epprozijetely_L:OO_A::_this dats &t the Anba g gador otel t012 "'2
wa8 8 truck__by 8 bullet fired_during 022 es 9889ination ettemet of_at6r
ROBiRT F KENNEDY _ MRS _ EVANS `e 9 taron t0 Central Receiying_Hosuite]
here she received_firat_eid_ She we? trangferred #he_ Huntington &nFi
Hogital bi GOODHII__urbylgnee
MRZ E EVANS privste docto L o A KIILIAMS is 8, rosi dent of_the Huntirstn
this i9 the reasor for 6h8 trensfer MRS EVAN S wa J od:itted by DR _ #AT
who 19 098isti0z Ln the ab Jence of DR WILLIAMS NRS EVAS WEs sd.ittm:
Copies to Copicg by Irdc cdby Nord cd cfler P:';
0 DET BUR 230 $ 76a
T,L . ELA:,
98 Wc PACE 2 0f Tko PAGz REPjrT
312
2
Ang
fnz;
Daj
Fhcte}
{Seugy g
onley_
No?
Eycs p?
+2_
==================================================
Page 41
==================================================
Police PEfaRTwient ixvtstigition RfoRt F{c Fulz 112 PASPoINA
Posadcna, Cali:. F 1w
Classllicotion
7UTSITE A33131) catc 0f tAis rport Casc numbci
2,G.-217, ATFEPT' XURDE? 6-5-68_ Wedna 565 994
REFERENCE To: Y.
EV A43 , Elizabath
F/1 42.
to the Flun Gington Hospital t 2:35 4 . %
DR CU34, tho Enorgoncy doctor , 0xamlinad MRS EVaNS . Ha
Iound tbat she had boen shot Tho bullot entoyed tbe sc &lp
0f" the forehead just balo:t tha hair line, 0ff center t0 tha
rlght and travclod upard t0 Dpproximately 0n & inch ( 1 " ) ebovo
ths hair ling h: bullet dd not 0xf t 01 penetreto the okull:
X r8y8" indicate that tho bulle t fJartened itself' 03ain3t ths
skull
DR RAVSI 0 al90 exaninod MRS EVAVS . Hq decided to l04v0
tha .bullet in th? scalp ana havr 2 surg0on r'emove it loter thig`
Iorning Ho adiitted MRS EVANs t0 tho hospital
Tho nur3e g on
duty $8id that 2 Iaan identified
23
ARTHUR
KVANS , tho vicrim 8 husbend , X23 proscnt wlth DX_ RAVELO .
Upon offic0rs.ELWELL end CASs'. arrival) DR . RAVEL,0 and
MR& EV AXS hed departodo D? CUB4 N2] intorviewod and lhe
aforenentioned information obtainad
6
SCT C INNBS notified Le4,P e D, Hiomlcido Divisicn, that
MRS EVAN S was in tho Funtington Hoapital
Officc:r$ EL,XELL Enal CAsS Met pith SG? CURCORAN (#;2840)
02d SCT LZwIS (45750) of La4.2.D _ Detectiv? Headcuer
Cantrel Diviaion ., KA 4-5211 I 2504 411 information obiained
Ka$ Liven to SGT CorCuAV and 8c] LEXIS,
A: `copj 0f MRS , EVANS c 0z1] 8 e1 & fox trentzont and admictance
for 5a8 obteinad and i9 attecnod co tnf9 report .
31*
8opi5s o Cpics Mio; iPpruvr 717.8&7ZFT
DET BUR ~3_
Ux
TaD ELNELI, P 731
PAZE 2 UP T#J PRcz RPJ
8d97:
601' &,
==================================================
Page 42
==================================================
Hor [663i l E2(-}A
Y406j42
7E35
pmone
Tutkkzey"
MXM GtSf rERN Pvt Ca;
folice CAR
2L4" [2uie Ccl
Eotpiteation Co GiLL To NiRz Omi
2
EE: TZh
C,P i cErT On MEMDR No. PkY This stheci
NMOUNT
GAoup No. Gomtict Dr Mosp DEN, coot occu7ajiom 67 Responsiole FARTY [3 Co R2.h1
53
Efns ()s tX-e*
WRItTEN DY_
Ctch
4 _3 EMERGENCY
Esx;L
Print Fikuly AUOvE Tiis Lini
DRciKjowm
of CMAGes
KG5 SEX RACE 0y WMPN REL4T €S No7if1zo aY Y{ EcLE ividowzo AX 4>
MaR7iEO DivoRCcO Lt)
3/ =
332
Kc -
PX
How_ MK}N Ao Wheac iNJuRY WAS #ustainEO 1 444,
CU_CL?
pbs ~LS_IL;
c
Luee tiat FLEd
4Ap4 (CL' 6,
(Ucs
4L6e_YC66-+2)
llzce 47571 A3L ~L
L?
ALLERCIES ZECE cc_u Ze Z3X Cc
H42441 24oz
FL2 AC 6
4 #4AEly_b2ILE 1ake
CLzr'L
6 L LysL_cLyg=
SL_tesls 6 92 2 22 72,2
14Lhe1ez:
StaFf Tif DY Whob TRE 4M FCGE_
202
Pm
Physical Finomgs (bku
{6eeyz
t
( Gxx
kuble" Ll 6O7&
9Yes:
physicians JiaGRosIs Rreaira Trukez9_
$ S;GNA{U?z DisChaRSEO To ReperrZJ 70 Uzs
X ilo 'uuxtud 7s
T44
CONSENT FOR TREATMENT AND FINANCIAL RESPONSISiLITY
KaVINS JEcN oMitTEO To TME ImeRCENCY dePaRTiiE iT OF TME Funtimgton Meko:AL HOSPitAL, Hrreor CONszn; 7J AA) {hjRizz
^dniniseritjn OR RLL treatxehts. incLUoing Suaefy Tkat MAY B€ consioered ADVIsAJLE OR MECESSARY IN TMtz JcoovenT Of
HospifAL'; PAYS:CMans_
UMOERS;AN? TAAT CKARCES ARE Kadz For ThE Usz 0 Tiie EMERSENCY Rooks_ SuRGEay X-RAYS_ LABoRATonr wonk. ARU?;_
ILSO Uvcrastino TRAT, (F ThesE chafCES ARE coviREO INSURANCE of AnY TYe_ 45 Nevertneless KY Pep;onii 0z
Fo3 ALL KoS?ifaL CNAFCES Tn: MospitaL Is Autkorized To Furnish inforBATiON FRoX PatienT & Reeoad To KMY iNSufieR Or Mlin" Quistio 0 Y SuCH INSURE7_ OR To ThE court IN CASF of L{CAL Action.
SIGNR FoS
paTiENT
Y
lls%Geldk-L
Ui
Vifn{7$
CzQz
0t1 DATC Adoress
"t#EDY 4SswmC REsPomsiol TY Foa ThE DAY#ENT Of hospital
c;lls F0n S"v;CES AND suprlicg RenOcGEc To TMc Above PajieN? _
NKMC
(L
WitncSs Datr Aconrss
York %?
Xus
155,
LLc
Ao" V_La (
cl
ZssD
"vm{ p8
PLS
CSecros TYn_"
EuAA bhl
Aii
dY
Lll2
==================================================
Page 43
==================================================
FD-3 02 (Rev. 4-15-64)
FEDERAL BUREAU OF INVESTIGATION
Dat8/7 /68
Lieutenant CHARLES HUGHES
9
Los Angeles Police
Department LAPD) , made available the following copies of
the Medical Treatment Record of the victims wounded in the
'shooting at the Ambassador Hotel:
These Medical Treatment Records are from the City
of 0os Angeles_
9
Central Receiving Hospitel, and are handwritten
copies of the originals
Lieutenant HUGHES advised that the originals of
these records are being utilized for the Grand Hearing,
being conducted on June 7
9
1968_ and are , therefore , not
available at this time The originals of these records
will be available through appropriate subpoena if required
for any Federal court proceedings at a later date
On 6/6/68 at Los Angeles_ California Filelp8_ Angeles_
by SA EDWARD A PLEVACKLsig/e8i Date dictated.6/7 /68
This document containg neither recommendations nor conclusions of the FBI. It is the property of the FBI and is loaned to
your agency; it and its contents are not to be distributed outside your agency_
Jury
56 156
316
==================================================
Page 44
==================================================
City Off LOS ANGELES RECEIVING HOSPITAL
MEDICRL TREATMENT" RECORD)
RAME (Last, Fifst, Midole) MIDRESS CiTY
6&La<
Bs
hkOS0 < LICenssl 7k
phome NurBER ScX RAcE ETRTAADATE AGE BIRTHPLACE occupaTion
M.SW.D_ ^; F
ACCIDENT LOCNTION ACCIDENT ([n!c ana Time) EMPLOYER
L1lA?l
2762
J;
3 X
StatcMenT 0F accinenit EMPLOYERS ADDRESS
Row ERTCRED? 0WALKED PBREELCHA!R @STRETCHER CARRIED IN BROUGHT IN EY EHPLOYERS PIOME i~cu
0 city AKBULANCE [ PRIVATE AmEULANCE PRIVATE CAR POLICE CAR ~
REMIARKS
L
c&l~ Jnc Cc 6i Lc
6-82-7n n"1 2 Fze_&i
((
Pt 20(7i Dccl<.cd < 1 <.
14zA %< 4194 677i
HOwT LEFT MOSPITAL AMBUCANCE CALLED BYc; WMERE TAKEN
WHEELCHIA[R
WALKED CARRIED
RELATIVES OR FRIENDS BY WWORI AcCORHPAmIED BY
NOTIFIED
0 YES 0 No
44 0
TRDUSTRIAL TNJURY IRSURANCE CARRIER SOCIAL SECURITY MQ_
0 YES NO
iS PRTIEIT TRSURED? SPECIFY TYPE (Blue Cross, Kaiser , CPS) MEMBER NUMBER GRCUP NUMBER CODE?SCMED_
0 YES NO
NARE OF SURSCRIBER: SURGEON ON DUTY NURSE ON Duty
I)6 H € 22il
RH 340--3-67
317
43
OG
L
Kts (2 < (l
pG : -
7 <-{
iL+
KS:
ls
==================================================
Page 45
==================================================
CLINICAL RECORD
WAS PATIENT ABLE TO ANSWER Blood Pressure TOTAL CHARGES Statement/Receipt No.
QUESTIONS INTELLIGENTLY? 0 YES D NO 5 EMERGENCY CARE: 32 07
WAS PATIENT UNDRESSED? Pulse Temperature Treatment 7 Ambulance Call Record No.
COMPLETELY
PARTIALLY Tetanus
Opinion andTor Findings: 4tkt
L-<LL iC
ALLl XS Lk
A + Lk % 4A7
@LaLeeiG ~i 4pA s
Treatment ond Advice:
24I G+d L~l
1
2
4~GCA
1} 5 47
(L ` x
kd ct
318
Narcofic Admin. Timel By Repecby Condition on Discharge
Az
Surgcon' $ Signatyre Paticnt' s Signature if Complete Exam Refused
i4(
5yt
HzA
==================================================
Page 46
==================================================
CEWTRAL RFC HosPiTA: V- 3
City OF LOS ANGELES RECEIVING HOSPITAL
MEDICAL TREATMENT RECORD
NAME (Last, First, Middle) ADDRESS CITY Zip
Sl
Lci
L C $- ' Llsz,~
PKONE NUMBER SEX RACE BIRTHPLACE OCCUPATION PII
< 373l6 F] €
Lc" ke
Ms W.D,
6
ACCIDENT LOCATION ACCIDENT (Date and Time) EMPLOYER Z
4 L
Lo_n ZAi:_
Kct/
STATEMENT 0F ACCIDENT EMPLOYERS ADDRESS
how ENTERED? WALKED WHEELCHAIR STRETCHER CARRIED IN BROUGKT IN BY EMPLOYERS PHONE
3
CITY AMBULANCE PRIVATE AMBULANCE JPRIVATE CAR POLICE CAR LE
REMARKS "~cnllll Pu 1 (-07+%1) Uuanft-px:
'7268 € cl:
Ll
Jnsl,
Kow LEFT KOSPTITAL AMBULANCE CALLED BY WHERE TAKEN
WHEELCHAIR
WALKED CARRIED C:
RELATIVES OR FRIENDS BY WHOM ACCOMPAMIED BY
NOTIFIED
YES No
OwcChs
INDUSTRIAL INJURY INSURANCE CARRIER SOCIAL SECURITY NO,
9
YES No
IS PATIENT INSURED? SPECIFY TYPE (Blue Cross, Kaiser , CPS) MEMBER NUMBER GROUP NUMBER CODESCHED.
YES NO
NAME OF SUBSCRIBER: SURGEON ON DUTY NURSE ON DUTy
Guske K
RH 340 3-67
;
i.y
264] 6
==================================================
Page 47
==================================================
CLINICAL RECORD
WAS PATIENT ABLE To ANSWER Blood Pressure TOTAL CHARGES Statement/Receipt No,
QUESTIONS INTELLIGENTLY? 0 YES NO
EMERGENCY CARE: 2_ 6 /
WAS PATIENT UNDRESSED? Pulse Temperature Treatment Ambulance Call Record No.
COMPLETELY
PARTIALLY Tetanus
Opinion and]of Findings:
ZZELF
bila_Uu_A 1412ls
Z" &
Trcatmenf and Advice:
1 3
24+ C+D
C;$
L1t&
Narcctic Admin. Time/ By Repeat/By Condition on-Discharge
2(
Surgeon' $ Signoture Patient's Signature if Complete Exam Refused
psaa Qaus Le
C~
CLpy
==================================================
Page 48
==================================================
Cz'TraZ REC, Kus?in
V-4
CITY OF LOS ANGELES RECEIVING HOSPITAL
MEDICAL TREATMENT RECORD
NAME (Last , First , Middle) AODRESS CITY ZIP
SXS iiib) 7 L-Ll4liLAS+ lacc
PHONE NUMBER SEX RACE BIRTHDATE AGE BIRTHPLACE OCCUPATION
MSW.D,
M:= F PII
L'w 1 (
ACCIDENT LOCATION ACCIDENT (Date and Time) EMPLOYER Z
L | (i
LsxG_ B &Iu
STATEMENT OF ACCTDENT EMPLOYERS ADDRESS
S` U
How ENTERED? WALKED WHEELCHATR STRETCHER CARRIED IN BROUGHT IN By EMPLOYER S PHONE
CITY AMBULANCE O PRIVATE AMBULANCE PRIVATE CAR POLICE CAR
Sl
{
REMARKS c'&xk__ Srreli ACJ
Vlo 7 (8 2 ASi 47_ 6 CyA
How LEFT HOSPITAL AMBULANCE CALLED 8Y WHERE TAKEN
WHEELCHAIR
WALKED CARRIED
RELATIVES OR FRIENDS BY WHOM ACCOMPANIED BY
NOCIFYES
No
0
INDUSTRIAL (NJURY INSURANCE CARRIER SOCIAL SECURITY No_
8
YES NO
Yj
IS PATIENT INSURED? SPECIFY TYPE (Blue Cross, Kaiser , CPS) MEMBER NUMBER GROUP NUMBER CODEZSCHED, ~
YES NO Jc 1 U
NAME OF SUBSCRIBER: SURGEON QN DUTY NURSE ON DUTY ZZ
L~LalzL ZX1_8 Z C
RH 340-3-67
4L4 (
(:S
Ls
'i[ <z `
LV
==================================================
Page 49
==================================================
CLINICAL RECORD
WAs PATIENT ABLE To ANSWER Blood Pressure TOTAL CHARGES Statement/Receipt No.
QUESTIONS INTELLIGENTLY? YES No
EMERGENCY CARE: 12.6.2.463
WAS PATIENT UNDRESSED? Pulse Temperature Treatment Ambulance Call Record No.
COMPLETELY
PARTIALLY Tetonus
Opinion andTor Findings;
LAUl SA~LXc
46_(
~E S S
Treatmenf and Advicc;
24 Z_Xne+` Lzb
91
JLS!L< ClL_ cesks_ iik i(
C4LL L 4(e LLC
Narcotic Admin. [Bx Repeat/By Condition on Discharge
Surgeon 5 Signature Patient' s Signature if Complete Exam Refused
4
LL2
4r_
Hz42
71
Timee
91
==================================================
Page 50
==================================================
Oro
CENTRAL REC. HasPitA
S
CiITY OF LOS ANGELES RECEIVING HOSPITAL
MEDICAL TREATMENT RECORD
NAME (Last, First , Middle) ADDRESS CITY ZIp
1L--le
C<
L e 16 2'
QL-
PHONE NUMBER SEX BIRTHDATE AGE BIRTHPLACE OCCUPATION
36 >7,3/$) M, Jl ~M:S.W.D.
7
PII
ACCIDENT LOCATION ACCIDENT (Date and Time) EMPLOYER Z
ii . 2" I< df-iE Vi
STATEMENT 0F ACCIOENT EMPLOYERS ADDRESS
S
L 7 '
S
How ENTERED? WALKED WHEELCHAIR STRETCHER CARRIED IN BROUGHT IN BY EMPLOYER 5 PHONE
CITY AMBULANCE PRIVATE AMBULANCE PRIVATE CAR POLICE CAR (S
REMARKS
ii_(
Li"Li 3 6 (
Luila S 4261 3_
How LEFT HOSPITAL AMBULAANCE CALLED BY WHERE TAKEN
WKEEESHASR CARRIED 6-c-Sl
~_ss_ la:c. lzr
{
RELATIVES OR FRIENDS BY WHOM ACCOMPANTED BY
NOTIfIED
YES No
V)
INDUSTRIAL INJURY INSURANCE CARRIER SOCIAL SECURITY NO_
8
YES NO
IS PATIENT TNSURED? SPECIFY TYPE (Bluc Cross, Kaiser, CPS) MEMBER NUMBER GROUP NUMBER CODE/SCHED_
YES NO
F
NAME OF SUBSCRIBER: SURGEON ON DUTY NURSE ON DUTY
D_L: QLEtn
RH 340-3-67
2 k 64 63
RACEU
G_
iell
41]
lii =
0