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The document appears to be a police report detailing an assault incident that occurred on May 22, 2014 between 4:15pm and 4:36pm at an address in Greensboro, North Carolina. The report provides information about the incident, victims, properties involved, and ongoing investigation.

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Ben Holder
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2K views

Report

The document appears to be a police report detailing an assault incident that occurred on May 22, 2014 between 4:15pm and 4:36pm at an address in Greensboro, North Carolina. The report provides information about the incident, victims, properties involved, and ongoing investigation.

Uploaded by

Ben Holder
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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#1

#2
#3
Att
Com
Agency Name
ORI
OCA
Date / Time Reported
Month Day Yr
Time
Hrs.
Crime Incident(s)
Crime Incident
Crime Incident
Att
Att
Com
Com
At Found Last Known Secure
S
Month Day Yr Time
Month Day Yr
Time
Hrs. Hrs.
M T W T F S
=
S M T W T F S =
S M T W T F S =
Single Family Multi Family
Victim Residence Type
Weapon / Tools Forcible How Attacked or Committed
Premise Type
Location of Incident Offense Tract
Yes
No
N/A
Case Status
Further Investigation
Inactive
Closed/Cleared
Closed/Leads Exhausted
Complainant Signature
Officer ID#
Unfounded
Cleared by Arrest
Cleared by Arrest by Another Agency
Death of Offender
Case Disposition:
Located Extradition Declined
Refuse to Cooperate
Prosecution Declined
Officer Signature Supervisor Signature
DCI-600F Rev.3/92
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) Sex Race DOB / Age Victim of
Crime #
Home Address Home Phone
Business Phone Employer Name/Address
Code Name (Last, First, Middle) Sex Race DOB / Age Victim of
Crime #
Home Address
Home Phone
Business 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
Unknown Yes
No
N/A
V1
Victim/Business Name (Last, First, Middle) Resident Status
Resident
Non-Resident
Unknown
Sex
Home Phone
Business Phone
Relationship
To Offender
Home Address
Employer Name/Address
VYR Make Model Style Color Lic/Lis Vin
Race DOB / Age Victim of
Crime #
Status
Codes
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
GREENSBORO POLICE
2014-0522-299
NC NC 0410200
05 22 2014 16:36
Assault - Simple Physical
05 22 2014 16:36 05 22 2014 16:15
515 State St, Greensboro NC 27405
OTHER RETAIL ESTABLISHMENT
P90
MO
1
KOTIS, WILLIAM MARSHALL III
1,
45
W M AQ
3201 STILLWELL RD , Summerfield, NC 27358-9710
0 0
SMITH, G. C. (CENT, F) (P4551) WEBB, D. C. (CENT, F) (P3626)
INCIDENT/INVESTIGATION
REPORT
I
C
N
I
D
E
N
T
D
T
A
A
V
I
C
T
I
M
O
T
H
E
R
S
I
N
V
O
L
V
E
D
P
R
O
P
E
R
T
Y
ID
Status
X
X X
X
X
Type: Person Business Society Government Financial Institute Religious L.E. Officer Line of Duty Other/Unknown X
X
X
Page 1
Mobile Phone
OT MARTIN, JODY LINNEA
5119 Cheviot Rd Greensboro, NC 274552223
OCA
Name (Last, First, Middle)
Sex
Home Address
Race DOB.
Status
Codes
L = Lost S = Stolen R = Recovered D = Damaged Z = Seized B = Burned C = Counterfeit / Forged F = Found
DCI Status Quantity Type Measure Suspected Type
2014-0522-299
S
U
E
D
R
U
G
S
Age
Business Address Occupation
Scars, Marks, Tattoos, or other distinguishing features (i.e. limp, foreign accent, voice characteristics)
Hgt Wgt Hair Color
Also Known As
Eye Color
Check up to 3 types of activity for each
Possess Buy Sale Mfg Importing Operating
INCIDENT/INVESTIGATION REPORT
Yes
No
Unk
N/A
Yes
No
Unk
N/A
Offender Used
Alcohol/Drugs
Computer
Resident
Non-Resident
Unknown
Primary Offender
Resident Status
Offender 1 Offender 2
Offender 4 Offender 5
Offender 3
Offender 6
Sex:
Race: Age:
Sex:
Race: Age:
Sex:
Race: Age:
Sex:
Race: Age:
Sex:
Race: Age:
Sex:
Race: Age:
Build Hair Style Hair Length Glasses
Hat Jacket Shirt/Blouse Tie/Scarf Coat/Suit Pants/Dress/Skirt Socks Shoes
Was Suspect Armed? Type of Weapon Direction of Travel Mode of Travel
VYR Make Model Style Color Lic/Lis Vin
P
S
C
T
Name (Last, First, Middle) Sex Race D.O.B. Age
Home Address Home Phone Phone Employer
Suspect Hate / Bias Motivated:
Yes No
WIT
NESS
/
Greensboro Police Department
O
F
F
N
D
R
X
X X
X X
N
A
R
R
On 05/22/2014 at 1636 hours, I responded to 515 State St., in reference to an Assault.
Upon my arrival I met with the complainant, who advised that on 05/22/2014 between 1615
hours and 1636 hours, an Assault occurred.
The investigation is ongoing at this time.
T
I
V
E
A
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Mobile Phone

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