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ARREST / NOTICE TO APPEAR 1 Arrest 3 Request for Warrant Juvenile Referral Report 2NTA 4 a eae O13. Misdemeanor O14. Traffic Misdemeanor Os. O06. Ordinance Other 2. Felony O 2. Traffic Felony Alias (Name, DOB, Soc. Sec. #, Etc.) Race mea ore “CER mplexion - White | - ~ America India Scars, Marks, Tattoos, Unique | Features ree o- ae Tigseaton 9 shape onaeaag a Bere val eee“ = j ND 1. Ci "3. Florida fi lel fa C. Suyol DMM 2 Goun 4. Out of State (Zip) (City) (State) Business Address (Name, Street) q INS Number Place of Birth (City, STD = 12 Co-Defendant Name (Last, First, Middle) Race Date of Birth 1. Arrested 2. i a . Juvenile ae Sree ool alll ee = Parent : Name (Last) (First) (Middle) Addrdss (Street, Apt. Number) (City) (State) (Zip) Business Phone ( ) we a The above address was provided by () defendant and / or () defendant's parents. The child and / or parent was told School Attended to keep the — Court Clerk's Office (Phone 355-2526) waa of ay change of address. O Yes, b Reason) 2A beatae D ‘acture/ D Barbiturate alia U. Unknown N. NA B Buy 0: Dal Prochooa! N. wr C. Cocaine M . Marwan of one Z. Other P. Possess 7. Frat ic Cultivate A. Amphetamine E. Heroin thetic ite Violation iiss Violation of ORD # TEDW ¢ SSE. aes IL Ga re y i “noel al "86-386 creer —cg ead Oy Y iia} N Charge Description ounts mestic Statute Violation Number aid ¥ bra N en CD Instruction No. 1 Location (Court, Room Number, Address) < Mandatory Appearance in Court CD instruction No. 2 You need not appear in Court but must Court Date and Time comply with instructions on Reverse Side. Month {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 TOT JAC Date JUVENILE dg cond “a “al ae Date Signed Signature of Defendant (or Juvenile and Parent / Custodian) HOLD for other Agency b Offiaé name: OER Dangerous =) Resisted Arrest Name of Arrepting Pricer (Pop) (PRINT) = DISTRIBUTION: WHITE — COURT COPY GREEN — STATE ATTORNEY YELLOW — AGENCY PINK — JAIL GOLD - DEFENDANT (N.T.A's ONLY) Name Verification (Printed by Arrestee) 07/26/17 Page 52 of 120 Public Records Request No.: 17-295 DOJ-OGR-00030650