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i RICHLAND TWP. POLICE pe@ tment - 322 School House Rd., Boo. Incident Report (Black Print Only) 1, Incident or Offanse SIMPLE ASSAULT 2701 4, Victim or Complainant 10. Work Phone a. Vv Ts Address . Zip Code | ston stown, PA 15904 N/A Aepoerted G 12. Relationship 13. Home Phone 14. Work Pho PRG Report Number 2,ffense Code (Ollice Use Only) ; 3. Incident Code Abe ttf ed | . Race |6. Sex Date of RicthlAg. i PT, ss Zip Code - Time renend ——— onnstovn _ca___| 1004 aa Where 18.House or Block No. 119. 20, Street Name or Number 21, St., Rd., Ete. 22.Apt. No. 23. Reporting Area 324. Zor Occurred: 7 Po st Rei chland 2 When 25. Date 26. Time 27, Date 8 29. Day of Week [Circle] 30. Time of Day [Circlel 931. Weather Conditions : Unk S M T W T F ST Unk Day Night Occyrred 6-13-94 1200 oO 12345 67] 6 1 2 Clear Race Codes: (W) White (1) American (CC) Chinese — ((H) Hispanic 32. Report Taken At Ci Other (Specify) (B) Black indian {J) Japanese = {Q) Other & Scene CJ Station CO Tele. 33. List Property ©) Stolen* CJ Recovered* © Lost Found 34. Summarize and Code Praperty Stolen and/or Recovered “(Code in Block 34) Description of Property 4 1. Stelen Local Sto! 2. Staten Local/Recovered Local tolen—Recovered Codes 3, Stolen Local/Recovered Elsewhere {Insert Code No. 4, Stolen Elsewhere/Recovered Locally | fin this column} a Stolen Recovered Property Classification [@ items | $ Value | ; $ Value | #* Items | $ Value A. Currency, Notes, Etc. Eetesircecerere) —_ laleletatetatetetd | | 8. Jewelry, Precious Metals SRS ees Ses || C, Clothing and Furs : ys perme vers dP Cd ne ee . F. TV, Radios, Cameras, Ete. 5 | Reese ee H, Household Goods eo: SE Se aa 1, Consumable Goods > NO PROPERTY LOSS ||. Livestock(Not! ncludeHschid Pewee [ates | | K.Miscellaneous(IncludeH sehidPetsiece| | Reseed ce OTALS EEE EEE Total Value of CO) Stolen O) Lost Property ........ cece cee cees TOTALS... Total Vatue of C1 Recovered (C] Found Property .......0e0cees 35, Operation ID 36. Victim Desires Security Survey? Vehicte: Make Mode} Year Estimated S Value O Yes O No C3 Yes OONo ©) Completed ! 37. Identification and Other Services: 7 None CO Agent . License No. State Yr.of Exp} VIN Number Admin, No. . , Cl Assisting Officer(s} ° Admin, Na. Admin, No, Admin, No, Color Other Identifying information CJ tatents 5 Phoros TJ Investigator. Admin, No. Admin. No. {Ci stolen (CSuspect (Cl impounded {Entered NCIC [Cleared NCIC Ci Rescue Gl Crane C1 Photo-Fit C) Fire Equipment . jC Recovered Victimized (J Seized OvYesQONo iGives Ono © Coroner ©) Otner [Specify] _ | 38. Witness Information Nace Home Addre Brief Summary of Information Provided i Home Phone a ~ TWork Phone Work Address | | Name ome A Brief Summary of Informatian Provided . b6 Home Phane Work Phone Work Address b7C { 40.Admin, No, |43. Case Status (Must Circle One) (Supervisory Use Ontv) | | 1.Unassigned 2.Open/Pending 3.Suspended 4,Closed 44, Case Disposition (Supervisory Use Only) CI 1. Untounded Cl 2. Cleared by Arrest — Adult ©) 3, Cleared by Arrest — Juvenile cI 4, Cleared Exceptionally — Adult 1 5. Cleared Exceptionally — Juvenile 39, Name of Benn ing Officer Nameo mer | 4 jaator Assigned 42. Admin, No. Em, 2020-6 pt Reporting Officer