1.

TYPE

OFFENSE/INCIDENT REPORT
INSTRUCTIONS ARE PRINTED SEPARATELY. IF ADDITIONAL SPACE
IS NEEDED, USE REVERSE OF FORM; IDENTIFY ITEMS.
2. CODE NO.

2a. SORT

42363

a. ORIGINAL

b. CONTINUATION

3. TYPE OF OFFENSE OR INCIDENT

4. CASE CONTROL NUMBER

overdose

73gg4

5. BUILDING NUMBER

c. SUPPLEMENT
OR FOLLOWUP

523262372

6. ADDRESS

13425

13300 S Elm Street

7. NAME OF AGENCY/BUREAU

8. AGENCY/BUREAU CODE

FAKE

9. SPECIFIC LOCATION

16629

11a. DATE OF OFFENSE/INCIDENT

10. LOCATION CODE

1234 S Lubert Dr
11a. TIME OF OFFENSE/INCIDENT

12-25-14

12:00p.m

12.
DAY

13a. DATE REPORTED

13b. TIME REPORTED

12-26-15

7:00 a.m

14. DAY

Sunday

Tue
s
15. JURISDICTION (X)

VEDINVOLNSPERSO18.

EXCLUSIVE
ID
CODE
(a)

62b

16. NO. OF DEMONSTRATORS

CONCURRENT

PARTIAL

PROPRIETARY

17. NO.
EVACUATED
0

NAME AND ADDRESS

(b)
Last Name, First, Middle Initial

Mike Wazowski

AGE
(c)

SE
X
(d)

RA
CE
(e)

INJURY
CODE
(f)

TELEPHON
E
(g)
HOME

BUSINESS

Consuela Velasquez

Number, Street, Apt. No., City and State

19. VEHICLE

STOLEN

c. MAKE

GOVT

PERSONAL

VANDALIZ
ED

RECOVERED

e. COLOR (Top/Bottom)

f. IDENTIFYING CHARACTERISTICS

g.
REGISTRATIO
N

d.
MOD
EL

SUSPECT

STAT
E

TAG
NO.

h. VIN

i. VALUE

a. NAME OF ITEM

b. QUANTITY

e. SERIAL NO.

f. COLOR

g. MODEL

i. UNUSUAL OR UNIQUE FEATURES

j. PROPERTY WAS

k. STATUS OF PROPERTY
RECOVERED

c. OWNERSHIP
GOVT

h. VALUE

SECURRED
UNSECURED

MISSING

PERSONAL

d. BRAND NAME

VALUE RECOVERED

PARTIAL RECOVERY

l. NAME OF ITEM

m. QUANTITY

p. SERIAL NO.

q. COLOR

r. MODEL

t. UNUSUAL OR UNIQUE FEATURES

u. PROPERTY WAS

v. STATUS OF PROPERTY
RECOVERED

n. OWNERSHIP
GOVT

s. VALUE

SECURRED
UNSECURED

b.
YEAR
a. STATUS

HOME
BUSINESS

YEAR

TAKEN 20. ITEMS

3;45

1300 S Elm Street

1523 Oak Ave

b. TIME END

Number, Street, Apt. No., City and State

Last Name, First, Middle Initial

a. TIME START
7:22

MISSING

PERSONAL

PARTIAL RECOVERY

o. BRAND NAME

VALUE RECOVERED

21. NARRATIVE (If additional space is needed, use blank sheet and attach.)

Man overdosed on pills . Maid found him on the ground this morning at 7. Trying to contact wife and kids.

GENERAL SERVICES ADMINISTRATION

23a. EVIDENCE

TIME

22. NOTIFICATION

NOTIFIED

YES

ARRIVED

a. Other Police
Agency

b. Fire Department

yes

c. Ambulance

GSA FORM 3155 (REV. 3/200)

NO

23b. TAG NO.

23c. TYPE

23d. WHERE STORED

on the floor in the bedroom

24. ATTACHMENTS (Mark X where applicable)

a. CONTINUATION SHEET

b. GSA FORM 3157

c. PROPERTY RECEIPT(S)

e. SUPPLEMENTAL

e. OTHER (Specify)

25. SUSPECT STATUS

a. NOT IDENTIFIED
b. GOVERNMENT EMPLOYEE

c. GOVERNMENT CONTRACT

26. DISPOSITION OF SUSPECT

a. ARRESTED
c. RELEASED

d. CITATION ISSUED

b. NOT ARRESTED
d. N/A

CITATION NUMBER

d. NON-GOVERNMENT EMPLOYEE

d. STATEMENT(S) X

f. OTHER ATTACHMENTS (Specify)

d. Building Manager

e. N/A

NOTE: Complete GSA Form 3157 where this is a Suspect, Att. Burglary, Burglary, Att. Robbery, Robbery, or a Weapon is used.
27. TIME
a. RECEIVED

28. REVIEWED BY

b. ARRIVED

a. TYPE
FPS

c. RETURNED TO SERVICE
29a. BADGE

b. SIGNATURE

d. DATE

c. NAME (Printed)

GG

29b. NAME (Printed)

29c. SIGNATURE

29d. DATE

30. CASE REFERRED TO

a. FPS
DETECTIVE

b. LOCAL
POLICE

d. FBI

e. IG

31. CASE

c. STATE POLICE

32. APPROVING OFFICIAL

a. SIGNATURE

a. OPEN

g. OTHER (Specify)

b. CLOSED

c. NAME (Printed)

c. UNFOUNDED

f. N/A

b. DATE

33. DETECTIVE STATUS

a. CASE NUMBER

b. HOW CLOSED
INACTIVE
MEANS

c. SUSPECT
ARREST

OTHER

f. VALUE OF PROPERTY
e. PROPERTY
RECOVERED

d. ENTERED NCIC

DEVELOPED

ARRESTED

g. CLEARED NCIC

YES
h. REFERRED TO

YES

NO

N/A

i. DATE REFERRAL ACCEPTED

21. NARRATIVE (If additional space is needed, use blank sheet and attach.)

NO

N/A

GSA FORM 3155 (REV. 3/200) PAGE 2