8/17/2019 PoliceReport (2)

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#1

#2

#3

Att

Com

Agency Name

ORI

OCA

Date / Time ReportedMonth   Day Yr Time

Hr

Crime Incident(s)

Crime Incident

Crime Incident

Att

Att

Com

Com

At Found Last Known SecureSMonth Day Yr Time   Month Day Yr Time

HrHrs.

M T W T F S=   S M T W T F=

S M T W T F=

Single Family Multi Fam

Victim Residence Type

Weapon / ToolsForcibleHow Attacked or Committed

Premise Type

Location of Incident Offense Tract

Yes No

 N/A

Case StatusFurther Investigation

InactiveClosed/ClearedClosed/Leads Exhausted

Complainant Signature

Officer ID#

UnfoundedCleared by ArrestCleared by Arrest by Another AgencyDeath of Offender 

Case Disposition:Located Extradition Decline

Refuse to Cooperate

Prosecution Declined

Officer Signature Supervisor Signature

DCI-600F Rev.3/9

CODES: V- Victim (Denote V2, V3) O = Owner (if other than victim) R = Reporting Person (if other than victim)

Type:

Code Name (Last, First, Middle) SRaceDOB / AgeVictim of Crime #

Home Address Home Phone

Employer Name/Address

Code Name (Last, First, Middle) SRaceDOB / AgeVictim of Crime #

Home Address Home Phone

Employer Name/Address

# of Victims Type Person Business

Society Government Financial Institute

Religious L.E. Officer Line of Duty Other/Unknown

Injury  None Minor Loss of Teeth

Broken Bones Severe Lacerations

Drug/Alcohol Use:

Internal Unconscious Other Major  

UnknowYes

 No  N/A

V1

Victim/Business Name (Last, First, Middle) Resident StatuResident

 Non-Resid

Unknown

Sex

Home Phone

Business Phone

RelationshipTo Offender 

Home Address

Employer Name/Address

VYR Make Model Style Color Lic/Lis Vin

RaceDOB / AgeVictim of Crime #

tatusCodes

L = Lost S = Stolen R = Recovered D = Damaged Z = Seized B = Burned C = Counterfeit / Forged F = Found

Person Business Society Government Financial Institute Religious L.E. Officer Line of Duty Other/Unknown

(Check "OJ" column if recovered for other jurisdiction)

Victim# DCI Status Value OJ QTY Property Description Make/Model Serial Number  

 Number of Vehicles Stolen Number Vehicles Recovered

 FORSYTH COUNTY SHERIFF`S  201603965

 NC 0340000 05 04 2016 00:35

 Robbery 05 04 2016 00:34 05 04 2016 00:33

8100-BLK Depot St, Rural Hall NC 27045

OTHER NON-RESIDENTIAL

 ZRH 

MOThree Armed Suspect Entered Business And Demanded Money From Victim Handgun

 3

 ROBERTSON, ZACHARY ALEXANDER1,

25

W M ST  

V2 THE DEPOT GAMING CENTER, 1,

V3 COFFEY, SANDRA KARI  1

33

W F

2 61 S $3,226.00 1

3 65 S $60.00 1

3 65 S $20.00 1

3 65 S $20.00 1

3 64 S $1.00 1

3 99 S $1.00 1

3 99 S $5.00 1

3 13 S $150.00 1

3 61 S $300.00 15

3 99 S $1.00 1

0 0

 PITTMAN, J. R. (2030) SNYDER, J. R. (1638)

INCIDENT/INVESTIGATION

REPORT

I

C N

IDE

 NT

D

TA

A

VICTI

M

OTHER S

I N

VOL

VED

PR OPE

R TY

ID

tatus

X

X

X X

X

X

X

Type: Person Business Society Government Financial Institute Religious L.E. Officer Line of Duty Other/UnknownX

X

Total Stolen Value: $3,784.00

Page 1

Mobile Phone

UNKNOWN 

USA

 ASSORTED

USA/Twenty Dollar B

 NC 

US CURRENCY 

 PURSE 

WALLET 

 HAND BAG

 PREPAID DEBIT CARD

SOCIAL SECURITY CARD

 KEYS 

 MAKE UP 

US CURRENCY 

 DRIVERS LICENSE 

Business Phone Mobile Phone

Business Phone Mobile Phone

8/17/2019 PoliceReport (2)

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OCA: 201603965

Incident Report Additional Name List

 Forsyth County Sheriff`s Office

Additional Name List

NameCode/# Name (Last, First, Middle) SexRaceDOBVictim of Crime # Age

Page 2

1

Address

B:

H:

Empl/Addr

OW EDWARDS, MICHAEL LOMAN 53 W M

  - -

  - -

1)

Mobile #:   - -

R_CS7NC 

  05/04/2016 12:50