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Home My WebLink About20010441.tiff . r CONNECTING CASE N . • 40.3lQ O CASE REPORT NO O r Apo STATE PATROL REASON/2 (additional into narrative) t pSE REPORT UCR ENTRY REQUIRED: Yes IN No O HOLD ORDER: YES O NO O Q TOW REPORT =4,6.4T . RorIryu ss oyf i aand•av sides•'loo.Any sd C,0MP r n RT ❑ AUTO THEF ORECOVERY veniele irnooundad or ydarad need by an aeloer of the OolarWo . flan patrol rollout a rNwae Isom an Ow of Iha Colorado stale pewee or• Ii FT/RECOVERY 0 OFFENSE REPORT byre ide taus actor rin.. a art 3 mCderoaanor and erne at.Nmenad e� Q THEFT REPORT Wo'rdw'^sedan II•t•tde.C.rA.s. �- �ULTEO TIME g AM LOCATION O/nc 0 PM tI� / • L'O J9 . DRIVER: RO=REGISTERED OWNER: Va.V1CTIM: w=WITNE53: LP.LAST PERSON IN POSSESSION: RP>•AEPORTING PARTY S•SUSPECT MI �" • 4 e HE�✓f�� ' - �_ CITY STATE ZIP CODE PLACE OF BIRTH (CITY.STATEI 1 �� • 4/1JA.1 STATE ' RACE SEX WGT. MGT. HAI• EYES HOME TELEPH.NE . 's UCENS• NUMBER AND TYPE , , 1 �QC--5-3• 6i./[ 8i2G' /r rrT�••\ I W t BUSINESS TELEPHONE .n ✓ KCJ--��I` MPLOYEA ADDRESS OCCUPATION-(aY pNAME �'�`. MI • .��DOB IJx:AL:£vUAITY NO. FIRST I OOc ILAS IrAME tatt:' ; `� I a a C`N , y.� STATE ZIP CODE a/t/ T AE NUMBS Sr' L1 r,v yE.� 4 O �C�/� ' HOT. HAIR EYES HOME TELEPHONE STATE RACE SEX WGT. W DRIVER'S:JCENSE NUMBER AND TYPE EMPLOYER ADDRESS OCCUPATION BUSINESS TELEPHONE W EMPLOYER NAME VEHICLE YEAR.. MAKE TYPE OR BOD LE LICENSE PLATE/TYPE `STATES / 7 � -O� C77.-- COLOR,4+ ' 7�7! b VIN -/ � � (TOP/BOTTOM) _I l"!.fe)( 1 r 7 / / L I)B 5-9/::.,{.., �7 3/LVC( J REASON TOWED: INVENTORY OF VEHICLE 1 TRUNK EXAMINED 0 YES 0 NO o CRASH 0 OTHER: 2 ' ABANDONED HAZARD • LISTOF PROPERrrTJJY — a CONDITION OF VEHICLE: 2 1-MINOR 2-MODERATE 3-EXTREME 3 , a .S .A .7 i1 �1— r_—, — .r r..., '9 -1 3 a-••- 1le • ..0 jG- VAWE OF PROPERTY W 1 - �_�l ...� VALUE OF RECOVERED Sf€ALW - (r—.... —��. 1• --.j- 3 jo X-- s OATE/TIME '15 '14 r 13 i 11 40Undaraemoq.. OWNER NOTIFIED ' r 0 MAIL 0 PERSON 0 OTHER: PHONE ADDRESS 70W COMPANY NAME f OATE/TIME RELEASED 8Y VEHICLE RELEASED TO: I SIGNATURE O�TOW OPERATOR • WARRANT SUMMONS/WARRANT CHARGE YES NO NUMBER STATUTE NUMBER I 11.._cc.M aE R� PF}•1 S __EA r.41L.2)_---Fns 9 t..Y Ix— _8.a7J,_VJ)__1 yc.Tz.24A c .4L a. call___D-,2_2i. f �._daLce S - �L9..r" ?r�-• OF..�'�CQ E.c- Q1c � ar O� F _. a j_-- a , - ROADSIDE AUTHORIZATION I AFFIRM THAT THIS INFORMATION IS CORRECT ANC TRUE: I authorize and accept responsibility for the above- • Captioned vehicle to remain where now parked,and SIGNATURE OF REPORTING PARTY understand that this vehicle MUST be moved within NUMBER REVIEWED BY pNITIALs) 24 hours,or it m3 be towed at the owners expense. DATE OF REPORT SIGNATURE Of F CER — OPERATOR `^ L' �,/,a7��r. /ifs(.-' 7Cl'/ - `�'l , .. YELLOW-JAIL PINK TOW OPERATOR GOLDENROD-VEHICLE Ow � .e.rlee.... r. -Mri FNTRYIFII£ 2001-0441 fa- CSP DUI File Case Number 00-3A-01200 Defendant: Mata-Hernandez, Ramon Address: Nunn, CO DOB: 05-08-62 CHARGES: 42-4-1301(1)(a) Drove Motor Vehicle under the influence of alcohol 42-4-1301(2)(a) Drove Motor Vehicle with excessive alcohol content in breath. 42-4-1401 Reckless Driving. Arresting Officer: J. R. Peters#7006 Colorado State Patrol 3939 Riverside Pkwy. #B Evans, CO. 80620 (970) 506-4999 Location of Offense: CO 85 1 mile north of CO 392, in the County of Weld the PTh State of Colorado. Date/Time of Offense: 0040 on 08-12-00 Roadsides Done: 0045 on 08-12-00 Custody Time: 0052 on 08-12-00 Express Consent: 0055 on 08-12-00 Blood or Breath: 0057 on 08-12-00 Blood/Breath Time: 0126 on 08-12-00 Witnesses: Trooper J. R. Peters Colorado State Patrol ' Evidence: Breath Test results for Mata-Hernandez showing BrAC at 0.205 Overview: On 08-12-00 at approximately 0040 hours I was patrolling CO 85 between Eaton and Lucerne, in the County of Weld,the State of Colorado. As I was patrolling southbound I observed what appeared to be a vehicle being pursued by a patrol car with emergency lights engaged, and they were northbound in the southbound lanes. As I approached the vehicles the Eaton patrol car had the vehicle stopped. The driver later identified as Ramon Mata-Hernandez had a strong odor of an alcoholic beverage on his breath,bloodshot watery eyes, and slurred speech. I asked Mata-Hernandez if he had Defendant: Mata-Hernandez,Ramon /111 „ been drinking and he stated "4, 5, or 6 beers". I asked Mata-Hemandez if he would be willing to perform voluntary roadside maneuvers, and he stated that he would. The maneuvers were done on a dry level, paved surface. During the roadside maneuvers, the following was noted. During the Horizontal Gaze Nystagmus the following was noted on Mata-Hemandez. * Mata-Hernandez would not follow the pen with his eyes. Mata-Hernandez stated that he did not understand the instructions for the rest of the maneuvers. Mata-Hemandez was arrested for the suspicion of operating a motor vehicle while under the influence of alcohol. Mata-Hemandez was advised of the Express Consent Law, and chose a voluntary breath test Mata-Hernandez was taken to the Island Grove Treatment Center for the breath test. The breath test was conducted at 0126 hours and showed that Mata-Hernandez bad a BrAC of 0.205. The test results and checklist are attached to this report. Mata-Hernandez was issued a summons to appear in court for the above charges. Mata-Hernandez was issued summons number 1594536. Mata-Hemanndee was released to the Island Grove Treatment Center. �.� 'Trooper J. R Peters#7006 Colorado State Patrol Defendant: Mata-Hernandez,Ramon RADO STATE PATROL IMPAIRMENT EXINATION REPORT rr ' GQL0 AM D.O.E. CASE NO. ft,� Flrst,M.S.) o ix� _ TIME OF ROADSIDES:• TIME OF ARREST: E speeding,Weaving,Failed to Signal to Stop,Wide Turning Violation,Careless/Reckless Driving, Tong Side of Road, opped on Road. US Other Equipment or Registration,Accident Checkpoint,Other. • _ o L;ghts. ,•.4?-. �L,, Erratic Other N To E MPRGENCY EQUIPMENT: No ' •,..OVATIONS OF TESTING•OFFICER CIRCLE WORDS DESCRIBING CONDITION • red• Unsteady Used Vehicle for Support ` Odor of Alcoholic Beverage: None Faint Moderate Stron WALKING OtheNrmat Vomiting Fighting ;.: Flushed Pale UNUSUAL Hiccoughing C n•Belching Lau•hin• FA C` . .n„ ACTIONS �k,,'. ,,,,_ Otner ATTITUDE Polite Hilarious Talkative Cocky 'e". Watery Bloodshot Pinkish oopera, Indifferent Sarcastic Profane a+:• E„ES 1 OilierNorm Ca Uncooperative leepy Rude ' • ;inert Unresponsive Insulting Reserved Silent Combative '..--_---•------- --- • Normal G eer Stuttering Confused CLOTHING Ord Slow Mussed Soiled Disorderly Sat` P Incoherent MumblingLoud ,J 4aoid Quiet • Re•etitive Thick Ton•ued Describe Type of Clothing: HAND orm. Slow Shaky Fast Fumbling sitter CoL,.16n5.) NA-1-- MOVEMENTS ' er VEHICLE Normal Unsteady Stumblpd Used Vehicle for Support FOPS FOOTWEAR c' wBay gOo7'S E't•T Other �r O6SE2 VE� ROADSIDE EVALUATION • • SUBJECT WAS ADVISED ROADSIDES ARE VOLUNTARY A YES ❑ NO C,^NDITICN- Snowpacked Grade DRUG INDICATIONS: Body Other: S ner raved Dirt Wet Dry TREMORS: Eyelid Leg LiGHT TONGUE: Blisters Bm-Gm Coating White Coating Li�HT+P;G Daviicht Lighted � Other: waHE NASAL: Normal Red Raw Other: P. Raining S Windy Other. 1\owing PLAIN: PUPILS: Normal Dilated Constricted t�aht eve AEDICA-CONDITION: YES .'Cl EX No or nt , , Left eve• CONVERGENCE Present i r34 ,:, .,. NYSTGN1US ONELEG STAND NYSTAGMUS HORIZONTAL GAZE LEFT RIGHT NOTE.Suspect-Hard Contacts Sways Y N Y N C YES �NO Raises Arms Eye does cci pursue smoothly Hops Distinct Nystagmus at max.day. Hoot Down r—+— Nystagmus onset before 45' VERTICAL: DYES NO CANNOT COMPLETE/OTHER:• (/J00C...ki Ado-r- a-dc<-`' P .1 CANNOT COMPLETEIOTHER: W,T,-0 iT_-PES OikILY, ',no:-/E.1 NEB• INSTRUCTIONS STAGE: • Cannot Keep Balance Begins Too Soon WALKING 1st 9 2nd 9 Describe Turn: STAG;: Slops Walking 7 0 _aepu Q ' Misses Heel-Toe '1 Steps Off Line 0 I�,41: Q Raises Amt �n Q Actual Steps TYPE OF LINE: ACTUAL IMAGINARY n CANNOT COMPLETE/OTHER: v INTERNAL CLOCK: ESTIMATED SECONDS DRAW LINES TO SPOTS TOUCHED ALPHABET: • 1 Performed Satisfactorily 0 YES 0 NO AS 30 SECOI - Subject's Ability to Understand All •RIGHT INDEX A LEFT INDEX GESCRIEE HOW RECITED: Instructions: OGood 0 Fair ❑Poor OVery Poor Describe: COUNTING: 1 Performed Satisfactorily ❑ YES CI NO PBT RESULT: DESCRIBE HOW RECITED: CSP 203(REV 1197)Front ARREST/EXPRESSED CONSENT OFFICER ADVISED SUBJECT OF EXPRESSED CONSENT: XYES C NO SUBJECT CHOSE C 81000 TEST BREATH TEST C URINE O REFUSAL ❑UNABLE EXPLAIN WHY: I'1 WITNESS: Bne8 <, NAME ADDRESS y Casco e w at witnesses wl tests to TEL.NO. r' /—N\ PASSENGER NAME(S) v DOB ADDRESS • CONDITION i DRIVER 1 VOLUNTEERED THE FOLLOWING STATEMENTS WHILE IN CONTACT WITH OFFICER: S TF'11 /4 t.Ab ./". -5-,, t9/P- Ca Sirede.S PHYSICAL EVIDENCE: I OFFICER OBSERVED OPEN pTf OPNE� ALCOHOLIC CONTAINERS IN VEHICLE OTHER EVIDENCE: . VISEMENT OF RIGHTS. A. YOU HAVE THE RIGHT TO REMAIN SILENT. YOU DO NOT HAVE TO ANSWER QUESTIONS IF YOU SO CHOOSE. ANY STATEMENTS YOU DO MAKE CAN AND WILL BE USED AGAINST YOU IN COURT.B. YOU HAVE THE RIGHT TO HAVE AN A I TORNEY PRESENT DURING QUESTIONING. C. YOU CANNOT AFFORD TO HIRE AN ATTORNEY,ONE WILL SE APPOINTED TO REPRESENT YOU BEFORE ANY QUESTIONING. D. YO AN DECIDE AT ANY TIME TO EXERCISE THESE RIGHTS AND NOT ANSWER ANY QUESTIONS OR MAKE ANY STATEMENT 1• OU UNDERSTAND EACH OF THESE RIGHTS? ( )YES ( )NO 2. DO WISH TO WAIVE YOUR RIGHT TO REMAIN SILENT AND ANSWER QUESTIONS AT THIS TIME? ( )YES ( 0 3. (IF#2 Y DO YOU WISH TO HAVE AN ATTORNEY PRESENT DURING THIS QUESTIONING? ( )YES ( )NO SIGNATURE OF SUBJECT SIGNATURE OF OFFICER D TIME INTERVIEW: WERE YOU OPERATING A VEHICLE? WHERE WERE U GOING? ON WHAT STREET OR HIGHWAY? WHAT TIME DID YOU START? DIRECTION OF TRAVEL? WHERE DID YOU S FROM? WHAT TIME IS IT NOW? WHAT CITY OR COUNTY ARE U IN N WHAT IS THE DATE? WHAT DAY OF THE IS IT? kT HAVE YOU BEEN DOING DURING THE LAST THREE HOURS? HAVE YOU BEEN DRINKING? WHAT? HOW MUCH? WHERE? HAVE YOU EATEN IN THE LAST 8 HOURS? ( )Y ( )NO WHERE AND WHAT? _ DO YOU HAVE ANY PHYSICAL DEFECTS? ' YES ( )NO IF YES,DESCRIBE ARE YOU ILL OR INJURED IN ANYWA ( )YES ( )NO IF YES,DESCRIBE ARE YOU TAKING ANY TYPE EDICATION7 ( )YES ( )NO IF YES,TYPE LAS OSE? DO YOU HAVE EPILEP . ( )YES ( )NO DO YOU HAVE DIABETES? ( )YES ( )NO DO YOU TAKE INSULIN? ( )YES ( 0 IF SO,LAST 0 ? 4 WHAT LEVEL OF EDUCATION DO YOU HAVE? YEARS WHEN YOU SLEEP LAST? HOW MUCH SLEEP? ER THE CRASH,DID YOU DRINK ANY ALCOHOLIC BEVERAGES? ( )YES ( )NO ( )N/A ADDITIONAL COMMENTS/QUESTIONS/NARRATIVE: .ett-F,,C 7.6 a fir " .4r7V Ede f,�jRyr7/.e. , • .^1 L ..ER S NATU MBER ' PRINT OFFICER'S LAST NAME • DATE i. •fit„, CSP 203(REV1/97)Reverse Lr y - STATEOF LOLOF.ADO E;1IDENTIAL BREATH ALCOHOL TEST 7€4, , INTOXILYZEF: ALCOHOL ANALYZEF' e<, 71': CO MODEL 5000 SN 64-00318'3 DATE OF TEST 08/12/2000 SUB NAME-HERNANDEZ ,FAMON,M SUB DOE{ _ AF:SST OFC:R=F'ETEPS I NSTR OF'. =PETERS OF REC:ERT DATE=OE/09/00 INTOX RECERT DATE=C)1/06/C" SIM M SOLUTION NO=0-07-04 COPY NO 1 OF 01 TEST Y.BRAC TIME AIR BLANK .000 01 : 5MDT CAL. CHECK . 102 01 :25MDT A I F: BLANK .000 01 :25MDT SUBJECT TEST .205 01 :26MDT AIR BLANK .000 0 1 :2SMDT XBRAC = CRAMS/"210 LITERS 4,(07046 OPERATOR SIGNATURE SAMPLE CAPTURE REQUESTED. ( -.D 'CONNECTING CASE NO. CASE REPORT NO�L.?� COLORADO STATE PATROL O 5-3 CASE REPORT UCA ENTRY REQUIRED: Yes No ❑ REASON HELD Iaeoleonal into,nnarrat,ef `NCIDENTREPORT 0 TOW REPORT HOLD ORDER: YES ❑ NO 42"3!O$. R000sa at moa,nd.d.MicJ.a•p■neny.Any owner,ep■ral er."----\ USTOOY REPORT 0 AUTO THEFT/RECOVERY 7.741:::1.4 mptoy..ar a .wqo Or f.M1O.flalgn er any eppainl.d au■teru■n whe r■N .a■ny v a,mpaund.d a ordered h.id'ey.n eak■r al IM Cobr■aa LIVESTOCK THEFT/RECOVERY ❑ OFFENSE REPORT Mini paurol"AIWA a rel.aw lam an oaks el IM ColoNda Atato panel at a O OFFICER ASSAULTED 0 THEFT REPORT Pa ns.d m j A ero t eommrta a R. 3 miaaemuner uq shell On pununea as DATE TIMEoggn 11•bt06,C.A.rSu at_ 0 AM LOCATION _ 1 CODES OR>•ORIVER: PO-REGISTERED OWNER: V-VICTIM: WsWITNESS: LP=LAST PERSON IN POSSESSION: RP-REI ORTING PARTY S-SUSPECT COO LAST NAME FIRST< j� �2 /�- •�/7 /} �'�� Ml 008 SOCIJA�L}SECURITY NO. !- AIOR S L61 I �i '1( I, )-rI ' "i/ "p-".<41 \ S "` V CITY SATE ZIP CODE PLACE OF BIRTH CITY,STATE) CO ORIvER' I N MBE NO PE _ � STATE RACE. SEX WG-T. H AIR EYE-S- HOME TBLE HONE M� j=x !�" . s b ,h�� 0EMPLOY_ NA EMPLOYER ADDRESS OCCUPATION BUSINESS TELEPHONE T S+ZE LAST NAME •_ /:AST Ml 00d SOCIAL SECURITY NO. 1 N AI'DS..S / c.—1 ) L(iirV 7144...es f ~ CITY STATE ZIP COOS rJ L • ,. ,-ca F'it'V DRIVER'S LICENSE NUMBER AND TYPE .. STATE RACE SEX WGT. HGT. HAIR EYES �H E TELEPHONE EMPLOYER NAME EMPLOYER ADDRESS OCCUPATION BUSINESS TELEPHONE LICENSE P ATTERYPE STATE VEHICLE YEAR Mk(!... TYPE ORNOYY E COLOR tT P/BOOM)7 p / VIN t5 W /C"- A.!41,1 I-7-- TF 1 X pi D pi at ioel 3 o -5 -72-- REASON TOWED: ❑ CRASH 0 OTHER: INVENTORY OF VEHICLE TRUNK EXAMINED 0 YES ❑ NO ❑ ARREST Z 0 Q ABANDONED HAZARD LIST OF PROPERTY____.4 - -' M CONOITION OF VEHICLE: '! I•MIN0R 2-MODERATE 3•€XTREME CC _•__ O • ,,,,----4 3 , A ,S ,6 7 a .------- • EL = •I• �— X10 pR ...r > 10 — -11 L VALUE • UJ VOF PROPERTY IS i 14 113 :14 i 30 Undormmoga - S JNOTIFED • OATE1TIM� r. 0 MAIL_..C PERSON 0 OTHER: =---r:C'' TOW COMPANY NAME ;{Ja;*Jy A00RESS PHONE • SIGNATURE OF TOW OPERATOR VEHICLE RELEASED TO: DATE/TIME RELEASED BY STATUTE NUMBER CHARGE WARRANT SUMMONS/WARRANT YES NO NUMBER . ca L?;‘-'r'471-/3 0/4/4) .044. - — ,) .) cc U L� --`` - CSLZa9--Lt2,E4_k;:444- - .._______ • 11— l .1-z _,.1.:.T-z ? )-ox v ,;:424. 22_/_ W Q "C Z - - - I AFFIRM THAT THIS INFORMATION IS CORRECT ANC)TRUE; ROADSIDE AUTHORIZATION SIGNATURE OF REPORTING PARTY I authorise and accept responsibility for the above OATE 0 SIGEp,ONATURE captioned vehicle to remain where now parked,and M SIGNATURE OF 0 fFICEA 'NUM8ER REVIEWED BY{INITIALS) Underotand Ib this vehicle MUST be moved within :249�cJl. `/M( hours it m��• �c*� awner9 expense. '�J%� OPEAATO• �j WHITE-CASE FILE GREEN-DATA ENTRY/FILE YELLOW-JAIL PINK-TOW OPERATOR GOLDENROD-VEHICLE OWNER/OPERATOR COLORADO STATE PATROL IMPAIRMENT EXAMINATION REPORT • SUBJECT NAME:(Last,First,M.I.) O.O. • '5 r) 3,73 • VEHICLE IN MOTION/STOP 1 D TIME OF ROADSIDES: j'2)) - TIME OF ARREST: ©2N/X PROBABLE CAUSE•Speeding, eavin `lied to Signal to Stop,Wide Turning Violation.Caretess1Reckiass Driving,Wrong Side of Road.Stopped on Road. �- Ran Off Road.No Lights.Other ent or Registration.Accident.Checkpoint,Other. • REACTION TO EMERGENCY EQLl1PMMFNT: Normal low Erratic Other LOCATION OF STOP' (----"houlder 2 In Tr c Lane Off Roadway No ShQujg r Other OBSERVATIONS OF TESTING OFFICER(CIRCLE WORDS'DESCRIBING CONDITION) '- . BREATH Odor of Alcoholic Beverage: None Faint(derate)Strong WALKING Normal Staggered Unsteady Vehide Su for Other �� FACE Normal Flushed Pale UNUSUAL Hiccoughing Belching Vomiting Fighting Other ACTIONS Crying Laughing EYES Normal ektilie . oodshot Pinkish ATTITUDE Polite d Hilarious Talkative Cocky ooperative Indifferent Sarcastic Profan? I Other • Sleepy Uncooperative I • Antagonistic Unresponsive Rude Silent Combative Insulting_ Reserved SPEECH Normal Blurted Stuttering Confused CLOTHING rde _) Mussed Soiled • Disorderly Incoherent Mumbling Slow Loud Rapid Quiet Repetitive Thick Tongued _ Describe Type of Clothing: l� �CL�� .�/!1 _r— \�°. e. HAND Normal ow Shaky Fast Fumbling MOVEMENTS Other VEHICLE Normal nstead Stumbled Used Vehicle for Support FOOTWEAR 1/ A .L IT Other _ . IYPE y (F6,/--5 ROADSIDE EVALUATION•. SUBJECT WAS ADVISED ROADSIDES ARE VOLUNTARY YES C NO CONDITIONS: SURFACE: av Dirt Wet •ry Snowpacked eve Grade 'DRUG INDICATIONS: . . Other: TREMORS: Eyelid Leg Body Other. LIGHTING: Da light Lighted ( tiny" Other: TONGUE: Blisters Brn-Grn Coating White Coating WEATHER: iaining Snowing Windy Other: NASAL: Normal Red Raw Other. MEDICAL CONDITION: YESCNo PLAIN: PUPILS: Normal Dilated Constricted MEDICATION: i1._Z/ CQNVERGENCE: Present Not ore, ent Left eve ,Right eye_ NYSTAGMUS';. •'! .j HORIZONTAL GAZE ONE LEGSTANO:. . i 4. NOTE:Suspect-Hard Contacts LEFT RIGHT O YES O NO Y N Y N Sways • Eye does not pursue smoothly Raises Arms Distinct Nystagmus at max,day. Y • Hops `^ Nystagmus onset before 45' fj fx Foot Drown VERTICAL:'❑YES Q NO ' • CANNOT COMPLETE/OTHER: CANNOT COMPLETE/OTHER: WACKANDIURN • . ; :..•,.:,,:....;; ROMBERGIModlfledAttentionl`-' • FINGER TO.Nt.SE , INSTRUCTIONS STAGE: nriot Keep Balance Begins Too Soon AGE G WKIN ST 1st 9 2nd 9 Describe Turn: 4•']r Stops Walking • Misses Heel-TaeA Au, • 0 f Q Steps Off Line Raises Arm ;fit. /-j.L•• ,O C L/:" Actual Steps E r I/ TYPE OF LINE: ACTUAL AGINA O Q CANNOT COMPLETE/OTHER: _ INTERNAL C CK: ESTIMATED SECONDS ALPHABET:' Performed S •sfactority YES a NC AS 30 SEC NOS DRAW LINE 0 SP TS TOUCHED DESCRIBE HOW RECITED: Subject's Ability to Understand All •RIGHT DEX A LEFT INDEX Instructions: OGood fir OPoor ❑Very Poor �. Describe:(" COUNTING: I Performed sf drily O YES ❑ NO l. DESCRIBE HOW RECITED: r PBT RESULT: CSP 203(REV 1/97)Front ARREST/EXPRESSED CONSENT I OFFICER ADVISED SUBJECT OF EXPRESSED CONSENT: YES C NO SUBJECT CHOSE: O BLOOD TEST BREATH TEST 0 URINE Ct REFUSAL C UNA LE( PLAIN WHY): WITNESS: Bneffy descnbe whet witnesses will test to: • NAME ADDRESS TEL.NO. PASSENGER NAME(S) DOB ADDRESS CONDITION DRIVER 1 VOLUNTEERED THE FOLLOWING STATEMENTS WHILE IN CONTACT WITH OFFICER: /440 5 i' 44.-- ! ,Q7 /l 41,,S PHYSICAL EVIDENCE: + OFFICER OBSERVED OPEN EMPTY UNOPENED ALCOHOLIC CONTAINERS IN VEHICLE OTHER EVIDENCE: ADVISEMENT OF RIGHTS. A. YOU HAVE THE RIGHT TOR AIN SILENT. YOU OQ N VE TO ANSWER QUESTIONS IF YOU SO CHOOSE. ANY STATEMENTS YOU DO E CAN AND WILL 8 SED AGAINST YOU IN COURT. B. YOU HAVE THE RIGHT TO HA AN ATTORNEY SENT DURING QUESTIONING. C. IF YOU CANNOT AFFORD TO HIREAN ATTO ONE WILL BE APPOINTED TO REPRESENT YOU BEFORE ANY QUESTIONING. 0. YOU CAN DECIDE AT ANY TIME TO EXERC THESE RI H S AND NOT ANSWER ANY QUESTIONS OR MAKE ANY STATEMENTS. 1. DO YOU UNDERSTAND EACH OF E RIGHTS 2. Ng-- 3. DO Y2OU WISH TO WAIVE YES)00 YOU WISH TO HT 7 NT E AN ATT Y P ESE TND ANSWER QUESTIONS AT DURING THIS QUESTIONING?THIS TIME?)YES( (Y S)NO ( )NC • SIGNATURE OF SUBJECT • SIGNATURE OF OFFICER DATE TIME INTERVIEW: WERE YOU OPERATING A VEHICLE? WHERE WERE YOU GOING? ON WHAT STREET OR HIGHWAY? DIRECTION OF TRAVEL? WHAT TIME DID YOU START? WHERE DID YOU START FROM? ' 41HAT TIME IS IT NOW? WHAT CITY OR COUNTY ARE YOU IN NOW? MAT IS THE DATE? WHAT DAY OF THE WEEK IS IT? WHAT HAVE YOU BEEN DOING DURING THE LAST THREE HOURS? HAVE YOU BEEN DRINKING? WHAT? HOW MUCH? WHERE? HAVE YOU EATEN IN THE LAST 8 HOURS? ( )YES ( )NO WHERE AND WHAT? • DO YOU HAVE ANY PHYSICAL DEFECTS? ( )YES ( )NO IF YES.DESCRIBE ARE YOU ILL OR INJURED(N ANYWAY? ( )YES ( )NO IF YES.DESCRIBE ARE YOU TAKING ANY TYPE OF MEDICATION? ( )YES ( )NO IF YES,TYPE LAST DOSE? 00 YOU HAVE EPILEPSY? ( )YES ( )NO DO YOU HAVE DIABETES? ( )YES ( )NO DO YOU TAKE INSULIN? ( )YES ( )NO IF SO,LAST DOSE? WHAT LEVEL OF EDUCATION DO YOU HAVE? YEARS WHEN DID YOU SLEEP LAST? HOW MUCH SLEEP? AFTER THE CRASH,DID YOU DRINK ANY ALCOHOLIC BEVERAGES? ( )YES ( )NO ( )N/A ADDITIONAL COMMENTS/QUESTIONS/NARRATIVE: QA-A .n .1z2 t x/44 OFFICER SIGNAT E&NUMBER PRINT OFFICER'S LAST NAME DATE e e a/) 1 CSP 203(REV1197)Reverse S`+ AT= OF f:OLOF:ADOi E'VTI DEN T Z L BREATH ALCOHOL TEST I NTOX I L'YZEP - ALCOHOL ANALYZER CO MODEL 5000 SN 64-003139 DATE OF TEST 09/30/2000 SUB NAME=GUF:I ERREZ ,FRAN' I Sic,J SUB DOB = AF:ST OFCR=COF'LEY I NSTF: OF' =C=:OF'LEY OP F:EI=:ERT DATE=06/OS/00 INTOX F:ECER'T DATE=01/06/00 00 SIM SOLUTION NO=0-07-04 C OF^' NO 1 OF 01 TEST XBE'AC TIME AIR BLANK .000 02:5OMDT CAL. i=:HECF':. . 101 02:S MDT AIR BLANK .000 02:51 MDT SUBJECT TEST . 154 02:51MDT AlF: BLANK ,000 02:52MDT X,BF:AC = GRAMS/210 LITERS OPERATOR SIGNATURE SAMF'LE _:AP , URE REDUESTED. CONNECTING CASE NO, CASE REPORT NO. COLORADO STATE PATROL �` O��J ,�O 4 • CASE REPORT UCR ENTRY REQUIRED: -Yes' No lJ REASONHELOtaaa,uanal,nlo,nnna„a1,,.„ 0 INCIDENT REPORT KTOW REPORT HOLD ORDER: YES 0 NO 21: "--\ CUS700Y REPORT 0 AUTO THEFT/RECOVERY Imo s I05. .Rena+al of iroppynE.d officio'•p.naih Any owns,.orlylor,w r z :".w+aura.Id.,Q ar.W/ppo c,v wawaon vrno nb•Fuel m n lrnou.1r or n whew ai or N.arch ilil 0 o❑ LIVESTOCK THEFT/RECOVERY �OffEN$E REPORT +uu .IrW"amen 1 r.INiI from an odiea pl IM Cob.ado 11111 moo a a • tqn.Pd.eovn arch troa+I eII.3 rnr.d.rn«nor Iw SAGO e.ourv.nN II❑ OFFICER ASSAULT£p 0 THEFT REPORT eroaaw m+Mien u•I•ioa.C.R.�. DATE TIME IkLAM LOCATION 0 PM 'S' /y r4 P 7 . - C . CODES OR-DRIVER, RO.REGlSTEPEO OWNER: V.VICTIM: W.wITNESS. LP.LAST PERSON IN POSSESSION: RP.AEPORTING PARTY S-SUSPECT CODE LAST/NAME NRST MI . DOB SOCIAL SECURITY NO. e 'm r AILL,Yi I- AOORESS - CITY STATE ZIP COOS PLACE OF BIRTH (CITY.STATE) DRIVER' IICEN E NUMBE AND TY f CO STATE RACE SEX 'NOT. HOT. HAIR EYES 'HOME TELEPHONE J H _MPL YEA NA;.IE EMPLOYER ADDRESS OCCUPATION ptJylM£5$TELEPHONE COOS LAST NAME FIRST - D r� f A an 008 SUG1..I SECURITY NO. (V V/RP,t. 4 .fri/3 e - I- AD ass _ 1 d.CJ CITY STATE ZIP COGS m DRpIVER'S LICENSE NUMBER AND TYPE STATE RACE SEX wGT. HOT. HAIR EYES HOME TELEPHONE = / •EMPLOYER AOORESS ,y OCCUPATION r� BUSINESS TELEPHONE • �'r1LIC SE PLATE/TYPE STATE VEHICLE YEAR MAME TYPE OR 800Y STYLE .z4 - 8.04 Co 19 _�c.a zsssAJ ..x /,z-,n4 di A 12. COLOR)TOP/80t VIN //AN ti/Nui/P_7a-"7—K 01.77 • REASON TOWED: • -,t CRASH a OTHER: INVENTORY OF VEHICLE -4nernrreimiriesi ES C-NO ,$ ARREST Z 0 ABANDONED HAZARD k/ 0 LIST OF PROP£RTY.....71P-T 5.._L.,..f�4...t_-.•_C(.6.77/47.5_______::._.__.........................-_ _. i1 / q CONDITION OF VEHICLE: xti I•MINOR 2-MODERATE 3-EXTREME 1 ' S-i-C7-C.XIS.,54•/%7-/iQ.fJ scc _•....-_____.... ..._..._._.__..__fm-i : r -I f. :;j��i 19 : •9 ��EL _ !L'f O_F.?.E,ri.l_lA'r.C.t.J.1C.r T I .._... I : X 10 �� `J _.__� > 16 t__�� 11 •- REI)(jE !7D STEAL VALUE OF PROPERTY . 153i1.1 d ,'1 �13 �12 10und.r�ras�q• S 5 • 7� OWNER NOTIFIED DATE/TIME 0 MAIL 0 PERSON 0 OTHER: TOW COMPANY NAME ADDRESS P ONE E ZTS ows�c -/ /ST d°�3i sIGNArua£CF � �� 2>I<ftE Y co ��a>3.T��-•/tZ7 up9L�, �' VEHICLE RELEASED TO: OATEITIME RELEASED BY L/vim {/� STATUTE NUMBER CHARGE WARRANT SUMMONS/WARRANT • YES NO NUMBER LI „2"_/_?_± .1_61/4_/____/).1.42: , • A _1_5- .4,5"•_.:T . z 4,1 Ll._:..1_.3eL-2 _c .._.__.D�1_.. r/__S&_. ___-. _ (T': // ?r11 • i`lt,� _^ _ 4^4. 4-fT,C-4 - .__ft_..__.l7 +_?- �— - . .._%��.r.,s-44...t - -_4._._.. ...-u.>!tLC.Ce-,4s-. '__c —mil/_•/t -& JY s-U__ca_s i P ce rt �-N, I AFFIRM THAT THIS INFORMATION IS CORRECT AND TRUE: ROADSIDE AUTHORIZATION .SIGNATURE OF REPORTING PARTY I authorize and le to reSponaibillly a abave- OiTE OF REPORT captioned vehicle to remain w oW parked.and SIGN E OF OFFICER _^e NUMBER REVIEWED BYZwITUL31 1 understand that this. UST be moved within �_ 24 hours•or it a towed at the OW WII'S eXPenae C�? YOQ .2 6 0 OR HITECASE FILE GREEN-DATA ENTRY/FILE YELLOW-JAIL PINK-TOW OPERATOR GOLOENAOO-VEHICLE OWNER/OPERATOR CSP 80(REV VEHICLE OWNER/OPERATOR: READ REVERSE Slur:rnoccin I v COLORADO STATE PATROL IMPAIRMENT EXAMINATION REPORT SUBJECT NAME:(Last,First.M.I.) 1 ij 0.O.a. CASs NO. VEHICLE IN MOTIQN(STCP 0290 TIME CF?C•s �� , �'-, rgC2.:? cs•c�s - i T::.,E>;F a�?- n 7 � L3 CAUSE•Sceec:r;-^::uvrn,•F lded:c S -at:�:.. 'nice ,.r-r•• EST Pan Cr!R:aa. .'No Lights.Cther$oacment or Rag: :rattcn c 'i her• n.C 7feld..:Y.�_,,,a�J�r;`nrr„'PICC:.y�.�� ICJ $:'-.a.C — l cC_� �e.:ac r.:.C:her• _ac. aElCT:C'I TO EMERGENCY ECUrP".1ENT- Nomlal Slow Erratic Ocr?r c,r.s nr•.xt r`P'Srnp• a,.,- €.T.,wr, - ',, (,'.:!orartvgv `!r CF.-,leer r.r-i. LC8SERVATIONS OF TESTING OFFICER/CIRCLE WORDS CESCRISING CONDITIONI r 3REATH Cdor otAlconclic Beverage: None Faint •Iccerate treng WALKING ` Normal Staggered �3dv �a ce tor Suc_o �` "�� -- I Other _` FACE rn31� Fawned Pala U'fhter UNUSUAL I >-tir:ug:;ing deic::iry Vrmt ciny • Fighting ACTIONS _ Cr""rta L3uchinc • EYES Ncrrnal Facer/ ucdsrat Pinkish I ATTITU0tE Polite EsGted Hiiarcus Talkative Cocky • • C:"ter • ccoeative tr.Gfferent Sar:as::c r.:fare Caret a Jieecy Urcacperauve Antagonistic Urresccrsive Rude • Si!ert Comte:me Insulting Reserved SPEECH Normal Slurred S:u,^.enrg Confused Incoherent M misli CLOTHING roery Mussed • Scaled Ciscrery rt9'�—• Sic�M 'Loud Racid etetcttve Thick To�ncued Describe Type of C:othing: Jc6 c .S %� s,� NANO Normal .Sow Shaky Fast runcclin� MOVEMENTS I Other F EHXIT ^cruel ns: Stumbled Used Vehicle!or Support FOOTWEAR I er TYPE �p6'..�I3y T • ROADSIDE EVALUATION SUBJECT WAS ADVISED ROADSIDES ARE VOLUNTARY C YES C NO • CONDITIONS: SURFACE: Paved Dirt Wet Dry Snowpaciced Level Grade DRUG 1N01CAT10NS: Other. TREMORS. Eyelid Lea 3C 'r Ceder LIGHTING: Oa'.iicnt Lionled Dark Other TONGUE: Blisters Em-Gm Coatirtc WTite Coatiro ' WEATHER: Or, Raining Srcwinq Windy Other NASAL Normal Red Raw Other. MEDICAL CONDITION: YES NO EXPLAIN: I,PUPILS: Ncrmal Dilated Ccnst bled VERICATION /�� \ CONVERGc"NCE: Prsenf Not... -sort '' Left eve RiCkt eve NYSTAGMUS • HORIZONTA GAZE ONE LEG STAND: NOTE:Suspect-Hard Contacts LEFT i� IGHT CI YES a NO Y N Y N Sways Eye does not pursue smoothly I Raises Arms Distinct Nystagmus at max.dev. I Haps Nystagmus onset before 45' I I Foot awn VERTICAL: ❑YES G NO CANNOT COMPLETE/OTHER' CAN T CO14tPL=_TE/OTHER: . WAI 1 ANn TURN: •is • ' I P! .7-- T N INSTRUCTIONS STAGE. -Cannot Keeo Balance Becins Too Sc WALKING STAGE: 1st 3 Tnd 9 Describe Tum: Slops Walking I 70 /� Misses Heef•Toe I �+a �► Steps Or Line I O r1 � t' -Raises Arm6c'k- .. ....771).-. 1 '\ Actual Stews TYPE GP LINE. C?JAL L'.1A.Gi tARY CANNOT COMPLET_'OTHER: L 1 INTERNAL CLOCK: ALPHABET: I ?.{o -a•qJ : EST1..iATc:r SE O IDS :- -_ ::S!a. .% YES NC .10 SECCIl�� =.r./Ll?:ES TO c?GT$Tvt:CH_.. �� ) -j';l? : _ I Ins:: :7 .:..,. -tG'r'T I::CBX A.L. T INCE'. :act on s '"^..::3GGocc C Fair CPocr C/err Poor r::: COUNTING: I P--'crr,o.3 Sa:a'ac only C YES C NO OESCRt2E HOW=_Ci TE7 ?3T RESULT: CS?203(RSV 1197)Front ARRE57/E(pRe5SE0 CONSENT OFFICER ADVISED SUBJECT OF E.IPR SUBJECT CH ESSED CO�ISe,rT' YES Q Nd C5SE: Q BLOOD TEST REATH TEST 0 URINE CAC:1J5AL C UN �.� WITNESS. NAME ADDRESS a^atly cttscace wnat wmassas wm Issary TEL.NO. • • • • PASSENGER NAME(S) 008 ADDRESS CONDITION DRIVER VOLUNTEERED THE FOLLOWING STATEMENTS WHILE IN CONTACT WTH OFFICER: • Yf A:4A, C4cr PHYSICAL EVIDENCE:�OFFICER OBSERVED Coati c. " �tPTY UNOPENED ALCOHOLIC CONT,iN£R5 IN VEHICLE YS EVIDENCE EVIDENCE: • ADVISEMENT OF RIGHTS. A. YOU HAVE THE RIGHT TO REMAIN SILENT. YOU CO NOT HAVE TO ANSWER QUESTIONS tF YOU SO CHOOSE. ANY STATEMENTS YOU 00 MAKE CAN AND WILL SE USED AGAINST YOU IN COURT. 8. YOU HAVE THE RIGHT TO HAVE AN ATTORNEY PRESENT DURING QUESTIONING. C. IF YOU CANNOT AFFORD TO HIRE AN ATTORNEY.ONE WILL 8E APPOINTED TO REPRESENT YOU BEFORE ANY QUESTIONING. • 0. 1, 00 YOU UNDERSTANO EACH OF THESE RIGHTS? ( )YES ( )NO YOU CAN DECIDE AT ANY TIME TO EXERCISE THESE RIGHTS AND NOT ANSWER ANY QUESTIONS OR MAKE ANY STATEMENTS. 2. 00 YOU WISH TO WAIVE YOUR RIGHT TO REMAIN SILENT AND ANSWER QUESTIONS AT THIS TIME? ( )YES ( )NO 3. (IF X2 YES)00 YOU WISH TO HAVE AN ATTORNEY PRESENT DURING THIS QUESTIONING? ( )YES ( )NO SIGNATURE OF SUBJECT SIGNATURE OF OFFICER DATE TIME . INTERVIEW: WERE YOU OPERATING A VEHICLE? WHERE WERE YOU GOING?• ON WHAT STREET OR HIGHWAY? WHAT TIME DID YOU START? DIRECTION OF TRAVEL? WHERE DID YOU START FROM? WHAT TIME IS IT NOW? WHAT CITY OR COUNTY ARE YOU IN NOW? WHAT IS THE DATE? WHAT DAY OF THE WEEX i5 R? WHAT HAVE YOU BEEN DOING DURING THE LAST THREE HOURS? • HAVE YOU SEEN DRINKING? WHAT? HOW MUCH? WHERE? HAVE YOU EATEN IN THE LAST a HOURS? ( )YES ( )NO WHERE AND WHAT? DO YOU HAVE ANY PHYSICAL DEFECTS? ( )YES ( )NO IF YES.DESCRIBE ARE YOU ILL OR INJURED IN ANYWAY? ( )YES ( )NO IF YES,DESCRIBE ARE YOU TAKING ANY TYPE OF MEDICATION? ( )YES ( )NO IF YES,TYPE 00 YOU HAVE •EPILEPSY? � LAST DOSE? ( )YES ( )NO 00 YOU HAVE DIABETES? ( )YES ( )NO 00 YOU TAKE INSULIN? ( )YES ( )NO IF SO,LAST 00SEE? WHAT LEVEL OF EDUCATION DO YOU HAVE? WHEN DID YOU SLEEP LAST? YEARS HOW MUCH SLEEP? AFTER THE CRASH.DID YOU DRINK ANY ALCOHOLIC BEVERAGES? ( )YES ( )NO ( )N!A ADDITIONAL COMMENTSIQUESTIONSlNARRATIVE G • OFFICER SIGNATURE G NUMBER PRINT OFFICER'S LAST NAME DATE /5l Co4°G,6-t/ -ZF � `.--.1'••F AT_ OF C.OLOPADO EVIDENTIAL BREATH ALCOHOL TEST IN T OX ILYZEF: - ALCOHOL ANALYZE:: CO MODEL 5000 SN S4-0031S9 DATE OF TEST 09/'24/'200 SUB NAME=ARINENTA,MARTIN,N SUB DOB = ARST OFC:R=COFLEY INSTR OF' =COFLEY OP RECEF:T DATE=06/05/00 INTOX F:EC:ERT DATE=01/04/00 3IM SOLUTION NO=0-07-04 COPY NO 1 OF 01 TEST %BF:A=: TIME A I F: BLANK .000 03: 1' MDT CAL . CHEC:F( . 100 03: 1'?MDT AIR BLANK .000 03:2(iMDT SUBJECT TEST .2G'2 c a3:2SMDT AIR BLANK .000 03:21MDT 7.BF:AC: = GRAMS/210 LITERS • OF'ERATOF: SIGNATURE SAMPLE CAPTURE REQUESTED. • CONNECTING CASE NO. CASE REPORT NO.--� COLORADO STATE PATROL J051("0 3 CASE REPORT , UCR ENTRY REQUIRED: Yes Z No O REASON HELD(adorhonalntomnarr�lrvel HOLD ORDER: YES O NO CSi 0/�INCIDENT REPORT ❑ TOW REPORT 42.13.l03. ANena s impounded whistes•pinery. opening,owner.ope ,or g CUSTODY REPORT 0 AUTO THEFT/RECOVERY •nPIMY•e el ary wa0e or urvwe slalwn ar any moomled ouatednn wne n4•pa eny we a imOounOM or ordered hdd Oy■n olhen of the Colored& LIVESTOCK THEFT/RECOVERY 0 OFFENSE REPORT slats atrot atilheut a reI•eae horn an&hoer el the Ceteaee seta petrol or a �\ bena Pee eeun oro•r commas a J mr•d•mwnor and AMP IN punished as ❑ OFFICER ASSAULTED 0 THEFT REPORT ,q prm.ded.n,.coon le-I•tee,G.P.O.. )ATE r� TIME U AM LOCATION C ' ,r- G / o Le CODES OR>•ORIVE•R: RO=REGISTERED OWNER: V=VICTIM: W.WITNESS: LP=LAST PERSON IN POSSESSION; RP=REPORTING PARTY S-SUSPECT COA E LAST NAME FIRST MI 008 'SOCIAL SECURITY NO, I�/)J i F COD ^ PLACE OF BIRTH�TY,,tSTATEI5 m DRIVER'S LICE S ❑ 7 // �� / � FFST Y 4 •�T. NOT, 4- CET(}[� ONE E N MB£R AND TYPE STATE RACE SEX WGT. H6T. HAIR EYES HOME TELEPHONE y /4%) w _ rl 1 S c' EMPLOYER NAME EMPLOYER ADDRESS OCCUPATION BUSINESS TELEPHONE • CI IF LAST NAME FIRST MI -77o$ SOCIAL SECURITY NO. N , I_ ADDRESS • CI�T(.�7 f STATE if, F ZIP CODE tu t0 tDRIVER'SLICENSE � UMBER YPE v� • ' STATE' RACE ' SEX WGT. HOT:. HAIR c'rES HomeTELEEPHONE a to EMPLOYER NAME EMPLOYER ADDRESS OCCUPATION BUSINESS TELEPHONE LICENSE PLA E/TYPE STATE VEHICLE YEAR MAKE TYPE OR BOGY STYLE -76 �{ 4-1* P c o 1a 77 �171-6.-1.4e047-- ap COLOR(TOP/BOTTOM) VIN REASONED: ____0TO 0 OTHER: INVENTORY OF VEHICLE TRUNK EXAMINED 0 YES 0 NO CRASH ❑ ARREST / (� ZO •.0 ABANDONED HAZARD .•••:• LIST OF PROPERTY ,.-, %,•, c6t5. .._._ k..u —•--•— Q CONOITION OF VEHICLE: - - .- t•MINOR 2-MODERATE 3-EXTREME •` RELIMINARY • ,. z 3 :9 5 :6 . :7 :6 -- /--•-,W 2 f—ice X19 9-• p ,.0 O f'r +j fi ,. _ L__�`� VALUE OF RECOVERED STEAL VALUE OF PROPERTY ii. - 'I1 IS ; (4 ;13 :Il z0Undertorriagm S 3 OWNER NOT IE .OATE/TIME 0 MAIL ERSON 0 OTHER: TOW COMPANY NAME ADDRESS PHONE • SIGNATURE 6F TOW OPERATOR VEHICLE RELEASED TO: .DATE/TIME 'RELEASED 8Y • STATUTE NUMBER CHARGE WARRANT SUMMONS/WARRANT NUMBER YES NO 1U L 2'`�'' /, v /1)A)- 1pl tfc - L�__ti6J .., tCC , / y} .L.:,2,5q) fir r«cZ,cZz�0.LS9l�J__._/ _ .___._.._..._,.._..._._ _�` /S1`�'b l3 _U !4 ilJTi4 r.,t�..�..,7a__ _.. i.F,r...____ ivirlT_—_.I.7..,;44.__ _/ _.._47AL_ •1l r�_ _1. i s GEC,$e. �2- ed.- v.._ /s.Q }-T __./a5/ c — ��. sly_ a -- _ ....__— —._._ CC Z i1.T 6'fec . �� I AFFIRM THAT THIS INFORMATION IS CORRECT AND TRUE: ROADSIDE AUTHORIZATION I authorize and acceot responsibility for the above- SIGNATURE OF REPORTING PARTY captioned vehicle to remain where now parked.and DATE OF REPORT SIGNATURE OF OFFICER NUMBER REVIEWED BY IINITIALSI understand that this vehicle MUST be moved within 24 hours,or it may be towed at the owner's expense I0-2 (2C 4 „T - 1,71ry OPERATOR WHITE-CASE /FILE GREEN-DATA ENTRY/FILE YELLOW-JAIL PINK-TOW OPERATOR GOLOENROO-VEHICLE OWNER/OPERATOR CSP 80(REV 3/95) VEHICLE OWNER/OPERATOR: READ REVERSE SIDE CAREFULLY STATE OF COLoF:ADO I DEN l AL BREATI ALCOHOL TEST - AL CHOL ANALYZE; CO MODEL 5000 SN 64-002189 DATE OF TES- 10/'29/'20 SUB NAME-F'EREA,SERG I O,N SUB DOB = ARS T OFC:R=C:OF'LEY INSTR OF =COF'i_EY OP REC.ERT DATE=0S/08/00 INTOX F:ECERT DATE=o1/06/oo SIM M 'SOLUTION NO=0_0?-04 '~. COPY NO 1 OF 01 TEST /..BRAT_: TIME AIR: BLANK .c,00 (i':41MDT CAL. c HECK .097 02 41 MDT AIR BLANF .000 O'2:41MDT SUBJECT TEST . 134 0 ':4'2MDT AIR BLANK .000 02:43MDT XBPAC = GRAMS/210 LITERS ;L--- OPERATOR SIGNATUF:E SAMPLE... ' COLORADO STATE PATROL IMPAIRMENT EXAMINATION REPORT SUBJEC"NAME:(Last,First,M-i.) (1O.B. CASE NO. r 171-1, 5C'R G.re) PJ ..y/4.4o G J? •VEHICLE IN MOTIONISTOP Gi2.41 T TIME OF ROADSIDES: i. - TIME OF ARREST: 01-/-2- PROBABLE CAUSE-Speeding,Weaving.Failed to Signal to Stop.Wide Turning Violation,CAreless/Reckless Driving,Wrong Side of Road.Stopped on Road, Ran Off Road, • • g ts. •ther Equipment or Registration,Accident,Checkpoint,Other. 1 K, L. <'..4'-i: o.v+-y /—^` REACTION TO EMERGENCY EQUIPMENT: Normal Slow Erratic tbec___-.) ice LL.;� 7rrz r`A/p4 47 LOCATION OF STOP: Shoulder IIIn Traffic_Lane Off Roadway No Shoulder Other . OBSERVATIONS OF TESTING OFFICER(CIRCLE WORDS DESCRIBI NG.CON DITION) BREATH Odor of Alcoholic Beverage: None Faint Msesta0 Strong WALKING Normal Staggered nsteady` Used Vehicle for Support Other FACE ^ •1140310 Flushed Pale UNUSUAL Hiccoughing Belching LaughingVomiting Fighting • er ACTIONS Crying EYES Normal atery shot Pinkish ATTITUDE Polite Excited Hilarious Talkative Cocky ••peratwe Indifferent Sarcastic Profane Other Ca — leepy Uncooperative Antagonistic Unresponsive Rude . Silent Combative Insulting Reserved SPEECH Normal Slurred Stuttering Confus'd CLOTHING --ZOrderi Mussed Soiled Disorderly Incoherent Mumbling Slow Loud -- Rapid Quiet Repetitive Thick Tongued Describe Type of Clothing: • T '/ �i 781-k c P-17,•13.• HAND Normal Shaky Fast cFLmtV1lrttp MOVEMENTS Other VEHICLE Normal (:,kfristeay Stumbled Used Vehicle for Support FOOTWEAR — S �� EXIT Other ROADSIDE;EVALUATION SUBJECT WAS ADVISED ROADSIDES ARE VOLUNTARY *ES 0 NO CONDITIONS: ' SURFACE: _paved •rrt Wet Snowpacked evel Grade DRUG RUG TREMORS: eN d: L Bod Other. Other: LIGHTING: Dayli ht 'hte ,-k1 Other. 3) /r -.4-'-r ' TONGUE: Blisters am-Gm Coating White Coating WEATHER: Raining Snowing noin Windy Other. NASAL: Normal Red Raw Other. - MEDICAL CONDITION: YES Cnv akPIAIN: PUPILS: Normal Dilated Constricted MEDICATION: 4 f OtiF C0NVERq NCE Present Not present Left eve Richt eve •NYSTAGMUS HORIZONTAL GAZE .,ONE LEG`STAND.. . - /*""`\ NOTE:Suspect-Hard Contacts LEFT RIGHT ❑YES ❑NO Y N Y N Sways Raises Arms Eye does not pursue smoothly x Distinct Nystagmus at max.day. . f k Hops Foot Down Nystagmus onset before 45' ? 1- VERTICAL: 0 YES O NO CANNOT COMPLETE/OTHER: CANNOT COMPLETE/OTHER: 'lntig LEy- S/{*a4T 'r WALK'AND`TURN: ,ROJERG fModifiedAttention] J FINQUITO NOSE' ,:: INSTRUCTIONS STAGE: Cannot Keep Balance Begins Too Soon WALKING STAGE: lit 9 2nd 9 Describe Turn: • Stops Walking _ Misses Heel-Toe O ` Slaps Off Line _ ! I Q Raises Art O n < L Actual Steps I TYPE OF LINE: ACTUAL IMAGINARY CANNOT COMPLETEIOTHER: O , 51`.f i~nl� 01V GL.�- ZS . ,A9O-,TA riles A, 771f x774, - INTERNAL CLOCK: ESTIMATED SECONDS D LINES TO SP S TOUCHED ALPHABET: I Performed Satisfactorily 0 YES 0 NO AS 30 SECOND DESCRIBE HOW RECITED: Subject's Ability to Understand All •FIGHT INDEX A LEFT INDEX Instructions: Mood air ❑Poor OVery Poor Describe: r•• :OUNTING: ( Performed Satisfactorily 0 Y ❑ NO DESCRIBE HOW RECITED: KIT RESULT: \ • * • /Li CSP 203(REV 1197)Front • ARREST/EXPRESSED CONSENT _I OFFICER ADVISED SUBJECT OF EXPRESSED CONSENT: XCES O NO SUBJECT CHOSE: Q BLOOD TEST !`( REATH TEST O URINE Q REFUSAL O UNABLE(EXPLAIN WHY): WITNESS: Briefly describe what witnesses will tests(ta: NAME ADDRESS TEL.NO. PASSENGER NAMES) 0O9 ADDRESS CONDITION DRIVER I VOLUNTEERED THE FOLLOWING STATEMENTS WHILE IN CONTACT WITH OFFICER: .TKs r r2t M CbuR A71'144-4,6 „fir ou5n, t it r—7M47' /340 PHYSICAL EVIDENCE; { OFFICER OBSERVED OPEN EMPTY UNOPENED ALCOHOLIC CONTAINERS IN VEHICLE OTHER EVIDENCE: ADVISEMENT OF RIGHTS. A YOU HAVE THE RIGHT TO REMAIN SILENT. YOU DO NOT HAVE TO ANSWER QUESTIONS IF YOU SO CHOOSE. ANY STATEMENTS YOU 0O MAKE CAN AND WILL BE USED AGAINST YOU IN COURT. B. YOU HAVE THE RIGHT TO HAVE AN ATTORNEY PRESENT DURING QUESTIONING. C. IF YOU CANNOT AFFORD TO HIRE AN ATTORNEY,ONE WILL BE APPOINTED TO REPRESENT YOU BEFORE ANY QUESTIONING. D. YOU CAN DECIDE AT ANY TIME TO EXERCISE THESE RI H AND NOT ANSWER ANY QUESTIONS OR MAKE ANY STATEMENTS. 1. DO YOU UNDERSTAND EACH OF THESE RIGHTS?n I�ES ( )NO 2. DO YOU WISH TO WAIVE YOUR RIGHT TO REMAI I^ I ENT AND ANSWER QUESTIONS AT THIS TIME? ()YES ( )NO 3. (IF#2 YES)DO YOU WISH TO HAVE AN ATTORNEY PRESENT DURING THIS QUESTIONING? ( ')YES (A NO CL- SIGNATURE OF SUBJECT et 4 — SIGNATURE OF OFFICER DATE /6'.2j'(90 TIME INTERVIEW: WERE YOU OPERATING A VEHICLE? WHERE WERE YOU GOING? ON WHAT STREET OR HIGHWAY? DIRECTION OF TRAVEL? WHAT TIME DID YOU START? WHERE DID YOU START FROM? -i 4AT TIME IS IT NOW? WHAT CITY OR COUNTY ARE YOU IN NOW? • -tAT IS THE DATE? WHAT DAY OF THE WEEK IS ITT WHAT HAVE YOU BEEN DOING DURING THE LAST THREE HOURS? HAVE YOU BEEN DRINKING? WHAT) HOW MUCH? WHERE? • HAVE YOU EATEN IN THE LAST 8 HOURS? ( )YES ( )NO WHERE AND WHAT? DO YOU HAVE ANY PHYSICAL DEFECTS? ( )YES ( )NO IF YES,DESCRIBE • ARE YOU ILL OR INJURED IN ANYWAY? ( )YES ( )NO IF YES,DESCRIBE ARE YOU TAKING ANY TYPE OF MEDICATION? ( )YES ( )NO IF YES.TYPE LAST DOSE? DO YOU HAVE EPILEPSY? ( )YES ( )NO DO YOU HAVE DIABETES? ( )YES ( )NO` DO YOU TAKE INSULIN? ( )YES ( )NO IF SO,LAST DOSE? WHAT LEVEL OF EDUCATION DO YOU HAVE? YEARS WHEN DID YOU SLEEP LAST? HOW MUCH SLEEP? AFTER THE CRASH,DID YOU DRINK ANY ALCOHOLIC BEVERAGES? ( )YES ( )NO ( )N/A ADDITIONAL COMMENTS/QUESTIONS/NARRATIVE .a /g- 4477Th tl / n.9ez. 4 Sr9 r4n T.' c ri-.ran rD Ncrl , /4't.!• ' beg Lc%r5 /TF-^f.1. tiG rd A Li- ,v7'/44-;74) Hs h , Z ALi T &v../7"4-2- --eZrttD - . dr✓.au.5E t''1k ( ?w,' dtr/ Dthf i ft. Y ice, , OFFICER SIGNATURE 8 NUMBER PRINT OFFICER'S LAST NAME DATE Qc f 020 p c0 CSP 203(REV1/07)Reverse CONNECTING CASE NO. CASE REPORT NO. COLORADO STATE PATROL COSA .)O3CS CASE REPORT UCR ENTRY REQUIRED: Yes El No$ REASON"ELD(addn10na1 rnfo narrative) - 0 TOWREPORT HOLD ORDER: YES ❑ N0,® A. wc:L2) covtiT•f' INCIDENT REPORT42.19.105. Release N.m 0 CUSTODY REPORTpounded v s i a •',inane,y;any lane.hsduor.or �� 0 AUTO THEFT/AECOV EAY employe ry any9 s mp ., nd a, du,.d . any anolIca, h III.C n wno r,beaaa any w!ud.impounded or o'dua0 n'wt W ae oxleu al the Colorado o LIVESTOCK THEFT/RECOVERY 0 OFFENSE REPORT slate ppawl wahout a',lees'from 15 Mike'el the Colorado slue patrol or a bona IIdi coon order COMMAS a class 3 m ad'meenor and snail be pum,hed an • ❑ OFFICER ASSAULTED 0 THEFT REPORT prwAed on swoon 11•I.106.C.R.S. _ GATE TIME Ni AM LOCATION . LZ3-os/"CO CV3C' 0 PM LrCUl9 R4/)7,4n/<.C C42GO $J C'oc-n ..,'9J_ , CODES OR>'ORIVER; RO.REGISTERED OWNER: V-VICTIM: W=WITNESS: LP=LAST PERSON IN POSSESSION: RP=REPORTING PARTY S-SUSPECT CODE LAST NAME FIRST MI DOS SOCIAL SECURITY NO. !� A_ L1JEL ..(0(,!4•0---,/ S: G I- ADORES$ CITY . STATE ZIP CODE PLACE OF BIRTH (CITY.STATE) U W O m RIVER'S-LICENSE NUMBER AND TYPE STATE RACE SEX WGT. HGT. HAIR EYES HOME TELEPHONE m h EMPLOYER NAME L M YE ADDRESS OCCUPATION BUSINESS TELEPHONE CODE LAST NAME FIRST MI DOB SOCIAL SECURITY NO. N H "ADDRESS CITY STATE ZIP CODE U W n DRIVER'S LICENSE NUMBER AND TYPE STATE RACE SEX WGT. HOT. HAIR 1 EYES HOME TELEPHONE m 3 (0 EMPLOYER NAME EMPLOYER ADDRESS OCCUPATION BUSINESS TELEPHONE LICENSE PLATE/TYPE STATE VEHICLE YEAR 'MAKE TYPE OR BODY STYLE COLOR(TOP/BOTTOM) VIN • • REASON TOWED: ❑ CRASH 0 OTHER: INVENTORY OF VEHICLE TRUNK EXAMINED 0 YES 0 NO ❑ ARREST Z 0 ABANDONED HAZARD _ Q - x. 1•p LIST OF PROPERTY.._ __...._._ s•,1G —J��.y[. .. _.. Q CONDITION OF VEHICLE: p -1 s/�� Y ^— +� I-MINOR 2-MODERATE 3-EXTREME .--.-- -- CC a l 5 J 1 :1)� :1a 19 •9 P R a ' - U - ( i j �11 10 t=tl i V -••+ REPlotkILPREDSTEAL •VALUE OF PROPERTY ' 190 Under<emoga S 5 11 'l9 )14 't9 12 OWNER NOTIFIED OATS/TIME ❑ MAIL 0 PERSON 0 OTHER: TOW COMPANY NAME AODRESS PHONE SIGNATURE OF TOW OPERATOR VEHICLE RELEASED TO: • DATE/TIME RELEASED BY STATUTE NUMBER CHARGE WARRANT SUMMONS/WARRANTNUM ER 'YES NO Ill W -•-- O ( a I _.-_....._......._.._._._._—'- .. ---._:- .._.._ _.._._ _._.. U 't '3. 4,a) i t)c`!�- (ay..,L hi .--.,L_(L. EIaCL AIL- UP r3 F7/.,A0 _1¢'i �- G'L(Ia' , o .)<,: _et4L;,r/QZz_ /_p. k.. -__r•-✓err .b!o .c!4:a ..(//)-a /N`yS;yGA%/..0e.G_.9SsLs �_4.aZ.7.7. WSTQI'Cz_ .! . s - .__ -- _.-.........___ --- ___.__..........._—_—---- .. --- > a •__.........__—_.. -..._ ._- _ - -- __.. c a a. z I AFFIRM THAT THIS INFORMATION IS CORRECT AND TRUE: ROADSIDE AUTHORIZATION �� • . ' I authorize and accept responsibility for the above- - SIGNATURE OF REPORTING PARTY captioned vehicle to remain where now parked,and DATE OF REPORT SIGNATURE OF OFFICER NUMBER REVIEWED 8?IINITIALSI understand that this vehicle MUST be moved within 24 hours,Or II may be towed at the owner's expense. G - ') -a A}.' 7QO/_ OPERATOR WHITE-CASE FILE l3REEN-OATA ENTRY/FILE YELLOW-JAIL PINK-TO ERATOR GOLDENROD-VEHICLE OWNER/OPERATOR CSP SO(REV 3/95) VEHICLE OWNER/OPERATOR: READ REVERSE SIDE CAREFULLY i lra `�c•G' CONNECTING CASE NO. CASE REPORT NO. • COLORADO STATE PATROL QO34000 1O CASE REPORT UCR ENTRY REQUIRED: Yes O No 0 REASON HELD(additional'nip in narrative) — HOLD ORDER: YES C11 NO If 14c` 146-7‘17— o �� 1NCIOEN7 REPORT 0 TOW REPORT 42't3.103. Rst.sse at' water,or V. J ' A� ❑ CUSTODY REPORT C AUTO THEFT/RECOVERY !m01OYas at nix' ny�oyoa9 ae awvl.vehicles or'iny.ppotmw oiupod.sn woo C' 7 Npso wry y.ntc,,imoo.n.d or ordwad hold by sn oalcsr at tIt.Colorado r\. 0 LIVESTOCK THEFT/RECOVERY 0 OFFENSE REPORT wata pseei*Maul a nlaaso hem an officer of the Colorado stale pats+or a pen. i40 noun ardw casamas s 3 misdstns.nor end shell be punished as O OFFICER ASSAULTED 0 THEFT REPORT ordvded in eectan te•t•toe,�,F#. DATE TIME C AM LOCATIONSCn/O(7 mf3 J Q t 15VO O ZJ.8 ❑ PM �S CODES DRORIVER: ROWREGISTERED OWNER; VwVICTIM; WwWITNESS: LP>•LAST PERSON IN POSSESSION; RP*REPORTING PARTY SaSUSPECT • FIRST MI 008 SOCIAL SECURITY NO. LAST NA E �7 �••� 1-V A ��}^^••�� i+��J�i v /� n ! /��fits CITY CO lo p ZIP C•OODE P7. CJS OF,B,IIRRTH TY�„ ^ W iacy` /+51'0 A-ve: 6,2 C d o 3I J r�Vr , co m OAIVER•S LICEN NUMBER ANO TYPE ST TE RACE. SEX WGT. HOT. HAIR j�Y�ES HOME T LEPH E EMPLOYER ADDRESS OCCUPATION BUSINESS TELEPHONE CODE LAST NA FIRST MI DOS SOCIAL SECURITY NO. r �2 a ll I J/t.' t!i'TC>:�/I F L. U ADDRESS ^, CITY ��1`rSG STATE ZIP CODE L 40 /}VE SaNi }Jezi 3 ORIVER'S LICENSE NUMBER ANO TYPE STATE RACE SEX .WGT. HOT. HAIR EYES HOME TELEPHONE 03 H EMPLOYER NAME EMPLOYER AOORESS OCCUPATION BUSINESS TELEPHONE LICENSE QS,ATE/TY E(�] STATE co VEHICLE YEAja,� MAKE r TYPE¢(i BODY STYLE At S.•JZ u . r ��Ar V COLOR(TOP/BOTTOM) IN i l�% :284 cd2 X34 rg 6'78o 3 REASON TOWED: ❑ CRASH 0 OTHER: INVENTORY OF VEHICLE TRUNK EXAMINED 0 YES 0 NO ❑ ARREST _ ❑ ABANDONED HAZARD Cj{, � / � a(4 C47-1.5O LIST OF PROPERTY _li4t _...— Q CONDITION OF VEHICLE: , 2 I-MINOR 2•MOOERATE 3-EXTREME — — •---_.._. �.. C0 C J J! zU. 3 �'42 t 3 ! •e + t 7 :s us �i 1171 4 -_ Itp-i �9� __ ✓ -_ + L--...J�� VALUE OF RECOVERED STEAL VALUE OF PROPERTY II t i 14 113 i 13 r I 20 Undwser.ioyn S t OWNER NOTIFIED DATE/TIME - 0 MAIL 0 PERSON 0 OTHER: -TOW COMPAIg N M 0 c PHONE 5-3.-/7�/ SfGNATU fLJ�VV�Si•• Alilti R l FE R VEN DATE/TIME RELEASED BY ii•BHARGE' ■ WARRANT SUMMONS/WARRANT STATUTE NUMBER YES NO NUMBER U3 W _ • O a U ,-Lt-.J i-4015 ,r/Prricr?4,41. tiJS . _//-25.-4" S 6142• /O--sp 4' hi_6 .L IP__.----- -- -- - _ -- - W _--•._ > c -- ,---\ I AFFIRM THAT THIS INFORMATION IS CORRECT AND TRUE: ROAOS(OE AUTHORIZATION I authorize and accept responsibility for the above- SIGNATURE OF REPORTING PARTY captioned vehicl@ to remain where now parked,and DATE OF REPORT SIGNATURE OF OFFICER NUMBER REVIEWS BY(INITIALS) understand that thla vehicle MUST be moved within //�J !In,r • �k 1 r'1`} 24 hours.Or it may be towed Si the owner's expense. 01/ -00 1� 903 1 ' 1 v OPERATOR ! _ WHITE-CASE FILE GREEN-DATA ENTRY/FILE YELLOW-JAIL PINK-TOW OPERATOR GOLOENROO-VEHICLE OWNER/OPERATOR • CSP 80(REV 3/95) VEHICLE OWNER/OPERATOR: READ REVERSE SIDE CAREFULLY CONNECTING CASE NO. CASE REPORT NO. COLORADO STATE PATROL _GU-T,fc- 00 0 :7/n CASE REPORT UCR ENTRY REQUIRED: Yes ❑ No O ,REASON HELD(addffional into in narretwe) O INCIDENT REPORT TOW REPORT HOLD 0RDER: YES-i NO 0 , .0‘''.) 42.13-1 W. R•I•aa•of Impounded earldom•penally.Ail owner,operator,or • ❑ CUSTODY REPORT AUTO THEFT/RECOVERY employee oI arryr�aangs a aerrin 41:11011 01 ny appemlsd ouawdien who /.,� rabeas•any v4Mele impawq+d or ordered hede by so OIadN of the Colorado I LIVESTOCK THEFT/RECOVERY •O OFFENSE REPORT silo col without a release from an officer of the Colorado seam patrol or a ❑ OFFICER ASSAULTED ❑ THEFT REPORT Prowled„semiononle�-mnum yap 3 mrdem.anar sold shall he punished as 06.�.A.S. • DATE TIME 0 AM LOCATIO CODES- OR•DRIVER; RO=REGISTERED OWNER; V-VICTIM; W.WITNESS; LP-LAST PERSON IN POSSESSION: RPmREPORTING PARTY S•SUSPECT TCOOE LAST NAME FIRST MI OO8 JSOCIAL SECURlff p,, I- AGOREST CITY STATE ZIP CODE PLACE OF BIRTH (CITY,STATE) W 03 'DRIVER'S LICENSE NUMBER AND TYPE STATE RACE SEX WGT. HOT. HAIR EYES HOME TELEPHONE I EMPLOYER NAME EMPLOYER ADDRESS OCCUPATION BUSINESS TELEPHONE CypE n LAST N ME F,RST MI N !p[1 , A/� / „ t Z-4014-,�` A :77 COB SOCIAL SECURITY NO. ADDRESS ,(f N `! 7 /� J�� CITY STATE Z]P CODE lea . SE �d 6 vdf�v,) L A/ i.,/(,:•-t/.....-7-/.....-7- ��/ m DRIVER'S LICEN NUMBER AND TYPE. STATE RACE SEX WGT• HGT, HAIR EYES HOME TELEPHONE • N EMPLOYER NAME • EMPLOYER ADDRESS OCCUPATION BUSINESS TELEPHONE -LICENSE PLATE/TYPE STATE VEH ICLMAKE ' PE OR BODY STYLE C Z 7G -1-s"› (%6r.��7 _TYPE OR BODY STYLE ICL I 1/::::/71-) 77• G'.;•'•11 COLOR(T P/BOTTOM) VIN ' +I f��/JAY✓7 ti.,/:;-L/,.%• REA TOWED: ❑ CRASH 0 OTHER: INVENTORY OF VEHICLE TRUNK EXAMINED 0 YES 0 NO O ARREST Z ❑ ABANDONED HAZARD / 1yr O r LIST OF PROPEflT�yc-/ter /7 S/ �%�/�,<<- �.r of CONDITION OP VEHICLE: 2 I-MINOR 2-MODERATE 3-EXTREMECC _n ..-----N, 3, 143,3 Ii i7/ t ... U 1.1Q' - - �_�`�U a� VALUE OF RECOVERED.STEAL VALUE OF PROPERTY i 1371 •14' 1131 i I94 I / 20Und.rcamOQ.-.-.. s s r./ I / OWNER NOTIFIED DATE/TIME 0 MAIL ❑ PERSON O OTHER: TO O PANY NAME ADDRESS. PHONE f /i✓/ c: / .5' v f-z I NA e -- EHICLE RE EAS T : DATE/TIME R LEASED BY/ STATUTE NUMBER • CHARGE WARRANT SUMMONS/WARRANT YES NO NUMBER N W • C: .. 00 Z _.._I.__.,......----- C3 � 7 �i v- /free- r ,J"''� t-1 /If& r ()/Z I-u"% C.?' • Q ec • 4 � \ I AFFIRM THAT THIS INFORMATION IS CORRECT AND TRUE: ROADSIDE AUTHORIZATION SIGNATURE OF REPORTING PARTY I authorize and accept responsibility for the above- caplloned vehicle to remain where now parked,and DATE OF REPORT SIGNATURE OF OFFICER NUMBER REVIEWS BY(INITIALS) understand that this vehicle MUST be moved within , '/ r1 /� 24 hours.or it may be towed at the owner's expensr 7 f !/+� JZ- l--- � `� `1 r OPERATOR ` '�� WHITE-CASE E -DATA ENTRY/FILE YELLOW-JAIL PINK-TOW OPERATOR GOLDENROD-VEHICLE OWNER/OPERATOR CSP 80(REV 3/95) VEHICLE OWNER/OPERATOR: READ REVERS.? Rini rteat:as to I v �a //fa-Se/ CONNECTING CASE NO. CASE REPORT NO. COLORADO STATE PATROL al,,-1- oU d z_e CASE REPORT UCR ENTRY REQUIRED: Yes 0 No REASON HELD QddIUonal into Innarrativel O INCIDENT REPORT 4TOWREPORT HOLD ORDER: MESA' NO O � / _ 42.13.123. RN•ys�.y.it impounded wMNu•paneity,Any owner,0,r.ior,CH /�� /^�• O CUSTODY REPORT ❑ AUTO THEFT/RECOVERY empusiin vihlc isnpou dsz a eNind INIE M:ream Nmtod1M WAO Y erg en elado of a trot or e I LIVESTOCK THEFT/RECOVERY O OFFENSE REPORT elate pelrW without+MIAMI lrogm en*Meer d the Colorado Nate patrol or a J OFFICER ASSAULTED 0 THEFT REPORT pp�dsda i0*aiaponeie oe'C.R.g 3 misdemeanor sot Woe be punned as OATE TIME O AM LOCATION /�/—/5= Gu C) --,71) 0 PM t!'0 ''.—/9/,S J - . , A"C2 '�,e�j. CODES DR-DRIVER: PO-REGISTERED OWNER: V.VICTIM: W-WITNESS: LP.LAST PERSON IN POSSESSION: RP.REPORTING PARTY S•SUSPECT CODE LAST NAME FIRST MI t ooe 'SOCIAL SECURITY NO. I' ADDRESS CITY STATE ZIP CODE PLACE OF BIRTH (CITY,sure) W Oa Oa DRIVER'S LICENSE NUMBER AND TYPE STATE RACE SEX WGT. HOT. HAIR EYES HOME TELEPHONE J N EMPLOYER NAME EMPLOYER ADDRESS OCCUPATION BUSINESS TELEPHONE . CODE LAST NAME FIRST MI �,�f OO8 SOCIAL SECURITY NO. N (/4 _ ‘i C•,"sn67.- /44 4K C u r AOORESS , / TY STATE ZIP CODE - a l•' t t 7 C re 9 r f C./ r�"/1- G'V 3" 1 l n DRIVER'S LICENSE NUMBER ANO TYPE STATE RACE SEX WGT. HGT. HAIR EYES HOME TELEPHONE Of EMPLOYER NAME EMPLOYER ADDRESS OCCUPATION BUSINESS TELEPHONE LIC,VIE PLA/yV/TE/TYPE STATE VEHICLE YEAR MAKE /�!/� TYPE OR BODY STYLE CEO OR 0Pe ie. i -7 (_.-ii -� VI/N 9 3 `w 4.2.7-7,e /.1 //J C �7 �� REASON TOWED:- + "`,/4-! W.2"��I /.•�4.5,-O // O CRASH O OTHER: INVENTORY OF VEHICLE TRUNK EXAMINED O YES O NO ❑ ARREST Z O ABANDONED HAZARD 0 - LIST OF PROPERTY)[// 4:-.44-7-7,•*- c/4- ; ,t-e-i- 6 CONDITION OF VEHICLE: , / Q 1-MINOR 2-MODERATE 3-EXTREME Cy -/,ii — !'v/r J e (.4-5_j �" 7797'4\ .n Ai 7 7 Jam- e J ,,- rl17 'Ii , : 'iv'• r -- ' f. > t.__j VALUE OF RECOVERED STEAL VALUE OF PROPERTY Fr-, f} 3}>� i 7l Ii, i ly 3 2O Undo...reap s s .2.317._ - JS OWNER NOTIFIED DATE/TIME O MAIL O PERSON .O OTHER: TO COMRA AME ADDRESS PHONE .1,,,m is W OP R VEHICLE RELEASED TO: DATE/TIME RELEASED BY STATUTE NUMBER i CHARGE WARRANT SUMMONS/WARRANT YES NO NUMBER co , W . co K _ — V /.!,%/ j A/14.),,.‘,.--,‘, )7 // 3 (' , t /.1 -. 4:(c- i- /'n ,v11 y --77.4%./<",'",,..c-7-1—,, 7% W 4C z • .-....____..- • • I AFFIRM THAT THIS INFORMATION IS CORRECT AND TRUE: ROADSIDE AUTHORIZATION OF REPORTING PARTY I authorize and accept responsibility for the above- SIGNATUREcaptioned vehicle to remain where now parked,and 'DATE OF REPORT SIGNATURE OF OFFICER NUMBER REVIEWED SY(INITIALS) understand that this vehicle MUST be moved within I �y, 24 hours,or It may be towed at the owner's expense 1,[1L r/) r 1 � j�L�Xr. `.+ } OPERATOR crrr...� WHITE-CASE FILE/ SiREEN- TA ENTRY/FILE YELLOW-JAIL PINK-TOW OPERATOR GOLDENROD-VEHICLE OWNER/OPERATOR mere nn/Me,..n.. ! r ....... .-,..•r. .....��._..,., __..____ .. CONNECTING CASE NO. CASE REP T NO. COLORADO STATE PATROL PO ""?,t d oei7 CASE REPORT UCR ENTRY REQUIRED: Yes 0 No O REASONHELO(a00itlonalinfoinnx 111011 yyq HOLD ORDER: YES P1 NO 0Ate./12.,----7- /4 ❑ UN INCIDENT REPORT OW REPORT 42.13.103. Relies'of impounded seaidw-penally.any owner,opereter.V 0 CUSTODY REPORT 0 AUTO THEFT/RECOVERY .r.,0=6...,.;any�y.raga or ford:.elation or any appmnted cvswdlon who l at:o ra ie'PaundM ar a4ered hall by an iXnar of a Colorado �� ❑ LIVESTOCK THEFT/RECOVERY ❑ OFFENSE REPORT alas pQ.a1101 wilraM a M.ya Iron an ortbar el the Cobndo n.I.pa)ro1 or■ bOn,Ild.eeun efdar dommila tW 3 misdemeanor and shall be punished ea 0 OFFICER ASSAULTED ❑ THEFT REPORT P aNa in seetan t3•I•toe C.R. - DATE - TIM 0 AM LOCATIO Q.y A • / `` y ' /5 ,U 0 2 c/0 0 PM ✓,' /,�'iJ /' 5�/✓ C ��L'c'z-,/ . CODES OR•ORIVER: RO.REGISTERED OWNER: V.VICTIM: W-WITNESS: LP.LAST PERSON IN POSSESSION: RP-REI°ORTING PARTY S.SUSPECT CODE LAST NAME FIRST MI DOB SOCIAL SECURITY NO. v- I- ADORES CITY STATE ZIP CODE PLACE OF BIRTH (CITY.STATE) W m 'DRIVER'S LICENSE NUMBER ANO TYPE STATE RACE. SEX T WGf r MGT. HAIR EYES 'HOME TELEPHONE M L Y NAME L Y A OCCUPATION BUSINE T L PM N CapE LAST FhME / FIRST T MI DOB !Social SECURITY NO. c4 I :: I 5/ / z /A4 T/.✓ T'A/^T 1,144, : Zlrht!Q I_ A DRESS • CITY STATE ZIP CODE U //27., g-774 5 T .R t A T- gr./Z4 3 03 DRIVER'S LICENSE NUMBER AND TYPE STATE RACE SEX WGT. HGT. HAIR ' EYES HOME TELEPHONE N EMPLOYER NAME EMPLOYER ADDRESS OCCUPATION BUSINESS TELEPHONE LICENSE PLATE/TYPE STATE VEHICL YEAS 'MAKE TYPE OR BODY STYLE /m.4- Si c/ I fr�Uwr.i- ' 2 . COLQR�JOp/Qp M) VIN `T//`iii --1'^h/Ao(/4735.7-.2-3 ee:--C d A, ltl 5-4 REASON TOWED: ❑ CRASH 0 OTHER: - INVENTORY OF VEHICLE I TRUNK EXAMINED ❑ YES 0 NO ❑ ARREST / O 0 ABANDONED HAZARD LIST OF PROPERTY/S C e.V)7l/* c J`14-- 1-021e 5 i vt CONDITION OF VEHICLE: �7 j C�yJ ' Q 1-MINOR 2-MODERATE 3-EXTREME [�J! --- - -, 0 u. I 4 S r 6 7 Lis. --1( 3 ll. i r••••a , *, r---. 9i ≥ .} cT 14/_ ,`� S- VALUE OF RECOVERED STEAL VALUE OF PROPERTY a S S ' 119..,l I r 20 Undercarrio e " OWNER NOTIFIED DATE/TIME 0 MAIL O PERSON 0 OTHER: TOW OlfANY NAME AODRI(:AS P ONE .571.-.11/e(2-•duYL rDc,✓>rile. 3 v-- -5-'4/U SI ATUR70 °��J OR VEHICLE RELEASED TO: DATE/TIME RELEASED BY -.rle°1 WARRANT SUMMONS/WARRANT STATUTE NUMBER CHARGE NUMBER NO In W cc c.,) . L i nl l/-t jeep //✓ 3 e-9n l4-z /1/71r• Y✓X'.H'5 LEr . _ _. __._. �� 7-14-'.-t _ .._ ___. a 1,rJ�j� N 4 �� A,' � t 11 r til I AFFIRM THAT THIS INFORMATION IS CORRECT AND TRUE: • ROADSIDE AUTHORIZATION SIGNATURE OF REPORTING PARTY I authorise and accept responsibility(or the above- captioned vehicle to remain where now parked,and DtOF REPORT SIGNATURE OF OFFICER NUMBER REVIEWE BY(INITIALS) understand that this vehicle MUST be moved within / 24 hours,or It may be towed at the owner's expense. tp �I'/J ere Z(. V 7Z.T Z..- 4 ek \ l J 1 1OPERATOR_ WHITE-CAS ILE N- A ENTRY/FILE YELLOW-.TAIL PINK-TOW&PERATOR GOLDENROD-VEHICLE OWNER/OPERATOR CSP SO(REV 3/951 V HICLB OWNER/OPERATOR: PRA aR\/RRCF aloe r AoccI II I v • C 'Z o 0• CONNECTING CASE NO. CASE REPORT NO.n ^ ty - COLORADO STATE PATROL t /� 1CJtI O ( 1 CASE REPORT UCR ENTRY REQUIRED: Yes 0 No❑ REASON HELD I.aadianal info in narranvel ' HOLD ORDER: Y E S a( NO C. nc"Q4'cr r'4'6'37 77 �\ Q INCIDENT REPORT 0 TOW REPORT ' 1Z4 r.• Ral.aw al Wanundad venwaf•pMlally,Any OMMIC operator.01 d CUSTOOv REPORT 0 AUTO THEFT/RECOVERY 7.7.... of a1y qsnip or same.Buren a any aoo:4,7:1411r�an wire rMaafn any rahiela impeund.d er ordane held M see Cabratb - ❑ LIVESTOCK THEFT/RECOVERY 0 OFFENSE REPORT /tat*impel wnMut a eels**.Iran an onion of In.,Calmado maw oslrot on a Dona di court prier cornmes a Uafs 3 rlead.m..nor Ind INst be 9eNtisd II ❑ OFFICER ASSAULTED 0 THEFT REPORT PIOMdad m aadlon Il•I•lot.C.RS. DATE / 71ME 00 ,L/ ❑ AM LOCAT1N ` /L50 PM COOES OR=DRIVER: RO=REGISTEREO OWNER: V=VICTIM: W=WITNESS: LP=LAST PERSON IN POSSESSION: RP=REPORTING PARTY S=SUSPECT CODE --LAST NAM FIRST MI . 006 SOCIAL SECURITY NO. 1- ADDRESS CITY STATE ZIP CODE PLACE OF BIRTH (CITY,STATE) ' w 3/1/ I77` Ale 6,e z, Co go6y/ co DRIVER'S LICE ASE NUMBER AND TYPE STATE RACE SFXn- i GTj H Mtn EYES HOME TELEPHONE J -. 59r-- aCJ1C .0J• Ir 4eOJ_ 3.J�✓� tY P/- Ca/J N EMPLOYER NAME �� aMPa€�ADDRES� OCCI'PATIUN BUSINESS T LE H N L f C E LAST NAME L FIRST MI LOB SOCIAL SECURITY NO. CV O .5nml≤ L �� tcacC'liol F- ADDRESS ��} I CITY STATE ZIP CODE W m DRIVER'S LICENSE NUMBER AND TYPE -STATE RACE SEX WGT. HOT. HAIR EYES HOME TELEPHONE U) EMPLOYER NAME EMPLOYER ADDRESS OCCUPATION BUSINESS TELEPHONE • LICENSE PLATE/TTYY/PE �✓ STATEeo VEHICLE YEAA1l MAKE r_io TYPE�R�ODY STYLE zi.COLOR(TOP/80TTOM) '/ VIN • may^ f•' Ede giiifi s03 y,2V REASON TOWED: o CRASH 0 OTHER: INVENTORY OF VEHICLE TRUNK EXAMINED 0 YES 0 NO ❑ ARREST • Z ❑ ABANDONED HAZARD O - LIST OF PROPERTY__ .-_-....__. --- _. a CONDITION OF VEHICLE: 1-MINOR 2•MODERATE 3-EXTREME '-\ O U. Z 3 .4 .s 41 -- 7 ---U U r"- I . 10 - IL V r VALUE OF RECOVERED STEAL VALUE OF PROPERTY > i6 -- II 3 t I s ;14/ i,a 2 ; za Und..<ornda* S $ - OWNER NOTIFIED 'DATE/TIME 0 MAIL ❑ PERSON ❑OTHER: TOW C PANY NAME ADDRESS C /`l 7.- `' 1 :PHONE Z 1 NAT A R VEH L 5 ATE/ IME RELEASED BY 1 � j - STATUTE NUMBER CHARGE WARRANT SUMMONS/WARRANT i YES NO NUMBER f/) t ' . W __.-_— 13 . 2 _ �' _ ._-__.__ ..... U S C 4-A _i_P S°0 .' S-m-r ,rAeav 2-22-oo ____ At C16 3� -2-8= 0l 4 P c a .. -- _.—...__..�_._ .----_—._____ p--\ •I AFFIRM THAT THIS INFORMATION IS CORRECT ANO TRUE: ROAOSIDE AUTHORIZATION I authorize and accept responsibility for the above- SIGNATURE OF REPORTING PARTY captioned vehicle to remain where now parked.and DATE OF REPORT SIGNATURE OF OFFICER NUMBER REVIEWED v(INITIALS) understand that this vehicle MUST be moved within C}� A I t:3 20 hour;or it may be towed at the owners expense. DII S• - rt e: :;2 WA_ //03 1�� • � 4/l I'J OPERATOR WHITE-CASE FILE GREEN-DATA ENTRY/FILE YELLOW-JAIL PINK-TOW OPERATOR GOLDENROO.VEHICLE OWNER/OPERATOR r:CP An IPCV 1MF1 VPWIr'I F(lWNCO/rIOCPATno• ocAn 1,CI,COCC.o•r+- ••• COLORADO STATE PATROL I`� e9C-54-("c`3�7 CASE REPORT UCR ENTRY REQUIRED: Yes No O REASON HELD IAdd.II00 I,mO,n narrauret INCIDENT REPORT 0 TOW REPORT HOLD ORDER: YES NO +2.1S•tOS. Palermo 01 imwl+n0ld vM CI••-oen•xy.Any ow*. Doormat 4,r CUSTODY REPORT 0 AUTO THEFT/RECOVERY •mOlor•1 0l•4,y q•req•4,r a•..a stolmn or am+0Dant•o cualadl•n no 71'1••1 any r 0 1 0:',444 or nId•rm1 4,1,0 Op 14,•1Ker d m•Cobr•oo LIVESTOCK THEFT/RECOVERY 0 OFFENSE REPORT eau panel".nnom 4 4a•aa kern an newer d th1 Colored 41111 parol or a bona hat won order commas+4,1451 3 m.Wmpnor and LW 0.Oun,.n•1 a! r� 0 OFFICER ASSAULTED 0 THEFT REPORT Ororq•0 m 4•clion 14.1.10!,C.A.5. DATE TIME G Aµ I LOCAhhON • /�,=•-•.B.-4.....:•/ - ,•,•), L,:i `.' ,1 (7 i1 O CI ❑ PM I 6 4,,' r ( }/J /i i_L 4� l �'.• �/ /I J* CODES DR=DRIVER: RO.REGISTEREO OWNER: v.vICTIM: w.wITNES5: LP.LAST PERSON IN POSSESSION: RP.REPORING PARTY S-SUSPECT ----a DE LAST NAME FIRST MI ODB SOCIAL SECURITY NO, (�1g /` N Ti4 rT7 �t/-Li iIN • • W AOOR S / .fl} ,t L4� CITY/• r/ STATE• ZIP CODE 'PLACE I�OF BIRTH (CITY.STATEI DRIVER'S C£NSE NUMBER ANO- Pe /L7r l _..„ ,:.--_,-.7.:.-...-4_,-5-,f ��1�� -'� ( L•G1 (2J( ""C~� - (K m �,�. STATE RACE. SEX wGT. HG . HAIR EYE d HOMETE ?H E G(•5-- l C7 -c.' f 1�. Fil cX ) }fT e << <`� n /75 C-3- T3111 �17-')/1 EMPLOYER NAME EMPL TER AODRESS OCCUPATION BUSINESS TELEPHONE ----rCOOE 'LAST NAME FIRST MI OO9 SOCIAL SECURITY NO. N ,_ II }. AOORE5S CITY STATE ZIP r,OOF. U w m DRIVER'S LUCYNSE NUMBER AND TYPE I STATE T RACE T SEXWGT. I HOT. f HAIR r EYES HOME TELEPHONE • IL y EMPLOYER NAME EMPLOYER ADDRESS - 'OCCUPATION BUSINESS TELEPHONE LICENSE PLATE/TYPE I STATE VEHICLE YEAR MAKE I TYPE OR BODY STYLE COLOR I TOP/BO rTOMI VIN REASON TOWED: CRASH 0 OTHER:' INVENTORY OF VEHICLE • I TRUNK EXAMINED G YES 0 NO 0 ARREST f, Q ❑ ABANDONED HAZARD LIST OF PROPERTY -... ._ !,..4..-?____ •541,f;:-.•!,,15.::',._/-t‘ _ T-�•j _ - • ___ F CONDITION OF VEHICLE: 2 1-MINOR 2•MOOERATE 3-EXTREME _._..._._—.___.-_--....._.._.___...-._......._..._...___—_-.._..-_ ______.__.__.__.._-....._...._.....---._�._--'CC pREL_. UJ 7./1-- REP 1.ZT J 1 1171 :la .... Ti'l 1- `._.—..- ...,______..__.__ ..__.�..._. w VALUE OF RECOVERED STEAL VALUE OF PROPERTY > 10 - I ,- It ti.. ,, .2.1.12).- 1,I♦ 11J i 12 1 20Und..ornog• s 3 OWNER NOTIFIED DATE/TIME 0 MAIL 0 PERSON 0 OTHER: TOW COMPANY NAME AOORES`S PHONE BIGNATURE-OF TOW OPERATOR VEHICLE RELEASED TO: IOATE/TIME RELEASED BY STATUTE NUMBER CHARGE WARRANT SUMMONS/WARRANT YES NO NUMBER f,1-•4 'I/6 � �� /✓phi-. ,s`tuD�c.- free -r'S,J A s y�•yr _1-3--.1X. %II«) L ___— _ Q 4s-- .".g ,Ci'K4r�.s.,a 4�.4�y�tiL � r�2 yvL r ‘y:::-d.1- 7a>J f ui-v.2, J ..1.'� ::,�- --. _.-- — .. _ _._.. .__. !at :-- ..:-'4 7 /,)/4 1 r�la- 7 %a' //ra^l 1-4- L/li-r+ hr it r ; - a,L._ •' ii- !fi'2'- .�r'�,w �y�•-rf,i ' r� . �frc_,,fir /� _ .x � . y ct ,••J L.1r!''.1 c/ P._._/./5;14.. '.f itifi. /Y.J.__24;rw!�1'G_f:2?.4l' .',`'r_._.3o - ?'.o.1..!?'G1'I. ..I.`�'�//7,1: _'___.....• 4._..17./114.4. l G£�Ni��/.C.:. 4 _ r �5 .SJ/ - /►' ul_ ��L� Jim i J:�.G— , f�' a ---c . c��1x ter.. ._._.Sr i. -.,.4 5...........__,.... •__.._...._..._....., . __—.._.. _�_._ _..._..._-.._...___..._._.... ....... ..._ Z I AFFIRM THAT THIS INFORMATION I$CORRECT AND TRUE: ROADSIDE AUTHORIZATION SIGNATURE OF REPORTING PARTY I authorize and accept respona'bility for the above- captioned vehicle to remain where now parked,and DATE OF REPORT SIGNATURE OF OFFICER NUMBER REVIEWED BY'INITIALS) understand Pill this vehicle MUST be moved within •� 24 sus n. or it ay be IOwed at Ih owner' eapensa. 4.,t,1 ' • ,:t / ! OPERATOR 4 E1,,.` / . t WHITE-CASE ALE GREEN-DATA ENTRY/FILE YELLOW-JAIL PINK-TOW OPERATOR GOLDENROD-VEHICLE OWNER/OPERATOR CSP SD(REV 3145) VEHICLE OWNER/OPERATOR: READ REVERSE SIDE CAREFULLY STATE OF COLORADO EVIDENTIAL BENEATH ALCOHOL i EST INTOXILYZER - ALCOHOL ANALYZER CO MODEL 5000 SN 64-003373 DATE OF TEST 03/18/2000 SULK NAME=TORRE Z,HUMBRETO,N SUB DOB = ARST OFi_R=C:OPLEY I NSTR OF' =COPLEY OF' F:EiER;T DATE=12/04/99 INTOX F,'ECERT DATE=05/'27/9'Ii SIM M SOLUTION NO=9-09-01 COPY NO 1 OF 01 TEST XBPAC TIME A I F: BLANK .000 0 :5BMST CAL. CHECK . 101 0'2:59MST AIR BLANK 000 r 2:53MST SUBJECT TEST ( i 81 03:00MST A I F: BLANK .000 03:01 MST X BF:AC = GRAMS/210 LITERS OPERATOR S I i3NATUF:E SAMPLE CAF'TUF:E F:EOUESTED ,. • • • rn � saes • On 10-21-00 at approximately 2130 hrs I assisted Weld y D County ambulance, at the intersection of Colo. 392 and Colo. A - 85, with a drunk female who was believed to have injested .� some type of drug in a drink she was given. The subject, Aurora Dominguez 16 years old of 1208 6th St. #8 Loveland, " 1 was at Club Romance in Lucerne. Her sister Monica Dominguez, 18 years old, stated that Aurora had consumed 2 tequila mix drinks at the club and then was given a Sprite ( soda) and soon after began screaming and collapsed in the • bar. Monica stated that some unknown males had given the liquor and soda to her sister. Trooper Mike Escobar #2491 Hello