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OBTS Number RREST / NOTICE TO APPEAR 1. Arr 3. Request for Warrant F. Suvenite z Juvenile Referral ena 2 NTA 4. Request for Capias 2 ge.;cy ORI Number Flo, 5, 0, O, O, 0, 0 as apply. 2. Traffic ipa 4. Traffic Misdemeanor 1 Weapon Seized | Muttipie Clearance Enter Type % indicator Location of Offense (Business Name, Address) ADMINISTRATIVE eng te BP EE ES Tea Sh Ey : rs mae Te jor _ Mod Color Complexion Build - White - American Indian “ % 3 B- Black _O- Orienta/Asian i) pir PF. Fi SD JED 5 tr F ai ene Fo spe PEP i Uni it ion, i es Status Religion - _- ‘Indication of: -: fit pike Alcohol Influence es —— S Local Address Street, Apt. a : i (State) (Zip) wae a ? = wet : ee . Florida iS % 4 ‘ 3 IF ts ee: phe froth, re 23H »O) = SH 2. oy 4. Out of State ui Permanent Address (Street, Apt. Number) : : i Grote} ip) |) ; i g Leo adler’. Suites Sherr S ouga Business Address (Name; Street) (City) (State) (Zip) ig Teg D/L Number, State Soc. Sec. Number é - “Place of Birth (City, St t ) ; Citizenship _ a? Wew fee # FT] sr . | Co-Defendant Name (Laat; First, Middle) Date of Birth = 1. Arrested (3. Felony : Bi 0 2. At Large o 4. Misdemeanor oO C 5. Juvenile ~]9 [Co-Defendant Name (Last, First, Middle) | Race Date of Birth =. Arrested C'S. Felony o 5 2. At Large = 4. Misdemeanor 7 > 5. Juvenile (First) Ce ee Address (Street, Apt. Number) j (City: Tae, (State) (Zip) -. PNotified by: (Name) Juvenile Disposition 1. Handled/Processed within 2. TOT. HRS/DYS Released To: (Name) ——————Tationship L3 Parent La, Name (Last) 42 Legal Custodian LJ Other: Dept: and Released 3. Incarcerated : inline The above address w; vas provided =e defendant and / or 1) defendant's parents. The child are /-or parent was told to keep the Muvenia Cou Clerk's Office (Phone 355-2526) informed of any change of addres: LG Yes, by: (Name) } No: (Reason) Property Crime? Description of Property ot Value of Property \ CYes (No a N. NIA ‘ : K. Dispense/ M. Manufacture/. Z. Other pay Type B.-Barbiturate H. Hallucinogen P. Paraphernalia/ =U. Unknown Distribute Produce/ iA C. Cocaine M. Marijuana Equipment Z. Other Cultivate A. os a Ld E. Heroin O. Opium/Deriv. $.5 JZ ‘ Counts Gompatic. | 2 \ Violence ree cY ON Charge Description Counts | Domestic Statute Violation 3 Violation of —_ # byt Drug Activity] Drug Type Amount / Unit Offense # Warrant / i Ls if oP si Fe Charge Description Domestic Statute Violation Number Violation of ORD # ra ee CHARGE CHARGE wi Fe $<] Drug Activity] Orug Type | Amount / Unit. Warrant / Cans bi Number eerie oO Charge Description Counts Domestic | Statute Violation Number Violation of ORD # 3 bo er G Location (Court, Room Number, Address) Court Date and Time Month Day T AGREE TO APPEAR AT THE TIME AND PLACE DESIGNATED TO ANSWER THE OFFENSE CHARGED OR TO PAY THE FINE SUBSCRIBED. | UNDERSTAND THAT SHOULD | WILLFULLY FAIL TO APPEAR BEFORE THE COURT AS REQUIRED BY THIS NOTICE TO APPEAR, THAT | MAY BE HELD IN CONTEMPT OF COURT AND A WARRANT FOR MY ARREST SHALL BE ISSUED NOTICE TEAR Signature of Defendant (or Juvenile and Parent’ Custodian) Date Signed HOLD for other Agency Signature of aes Officer : Name: x é: : => one (1) Dangerous C Resisted Arrest Name of Arresting Officer (Print) ake Depu LO. # Tran iva Otficer Agency DISTRIBUTION: WHITE-COURTCOPY GREEN - STATE ATTORNEY YELLOW -AGENCY | PINK-AGENCY GOLD - DEFENDANT (N.T.A.'s ONLY) PBSO #148 REV. 8/97 Name Verification (Printed by Arrestee) DOJ-OGR- 00030397