I
_ , Case 3:03-cv-O1 O1 O-J BA Document 82-4 Filed O3/O2/2005 Page I · · I I I I ,
I 5 I ‘, _ · _ Outnzen Complaint Fog ) sf o . I Ig 3 o»a ;i.I_f;g§Q_ij;§‘_F I
I TO BE COMPLETED BY THE PERSON MAKING THE COMPLAINT I
I
DATE OF COMPLAINT: 2 *45 *0 4 TIIME OF COMPLAINT: I
I . ’ I
I NAME: sex: Az mm: ¤»= BIRTH; Z. é -.5*0 I
ADDRESS: 2 (,;*2 HQOZQ fig 5,271C 7-I PHONE NUMBERS:.._,5 ··{ 2 { I 1
WIT SSES ( NAMEIA DRESS SEX AG PHO I I
1. ,4 1 fc d O, !` * all - f 5 E NEEIUMEEE
2, a aa T-cr ..._. .._ <~
3. ‘ · I
OFFICERS INVOLVED: NAME BADGE NO. SEX RACE CAR NUMBER I
I- .L;_ 7 Ac %:%c I
2. 7, .? [L · —`__""'“_— r
3. ____;_____ ______ ___
DATE AND TIME OF INCIDENT: Z¥-gé ···0[ Egg- QQQO gg; LOCATION OFNINCIDENT: . _Q
F7/€0r)?'f J I I
WERE YOU ARRESTED?: ( _ )YES ( ;/ )NO WERE YOU INJURED?:( 4/ )YES ( )NO I
DESCRIPTION OF INJURIES: J/fe if ‘-
DID YOU RECEIVE MEDICAL TREATMENT? ( )YES ( )NO IF YES, PLEASE INDICATE WHERE
AND BYWHOM: &P7`"`gf§IQLgg6· @#72 cx; bf. [gg [@6*0 Q S ·
DESCRIPTION OF INCIDENT: (USE THE REVERSE SIDE OF THIS FORM IF MORE SPACE IS NEEDED: Q
I ·/ _.·-·¢,e L/ p .1 .;--C; .1. /4;. . 1,4 AJ ua r Iz .’ ,4---; I 4, ;,
. / I ··‘' _
ur I- .-.m.. A ,4, /1* . 4 .(¤4 . Az.:‘,{.,ql' ' / 4, I .. - .’ 41..-, .1.... I _- 4.44. ,7 ,4... .1.:..:.
. ./I "
I AM A ARE OF THE OBLIGATION OF AN OATH AND OF THE FACTS HAT THE KNOWINGLY GIVING OF
EITHER A FALSE STATEMENT OR FALSE INFORMATION IS UNLAWFUL AND PUNISHABLE BY LAW UNDER
SECTIONS 53A·-155 ANDIOR 53A·157 OF THE CONNECTICUT GENERAL STATUTES.
IF YOU FEEL THAT YOU NEED AID IN COMPLETING THIS FORM., YOU MAY CONTACT ANY AGENCY
INCLUDING THE NAACP AT 377-4875, THE SPANISH AMERICAN DEVELOPMENT AGENCY (SADA) AT 333-5193, I
OR THE PUERTO RICAN COALITION AT 368-6781 . _ ___ I
.. I
DATE: ?'"/y TO! SIGNATURES ZZ;/' · I
OEFICEB INITIAL BELOW SUBSCRIBED AND SWORN TO BEFORE ME ON · I
COPY OF CC-1 TO CITIZEN: THIS [E 9*6* DAY OF ’I‘9;7‘2?/
FILE CARD COMPLETED:/ `
FILE NUMBER; 0/09 /'€’» 0
· SIG ATIJRE OF INDI DUAL ING OATH
1* Q ` I
OIA: DATE COMPLAINT RECEIVED: 9 CASE NUMBER ASSIGNED:
ENCLOSURE A
FORM CC-1
REVISED: 1071997
<1I·~rI¤* I
/{/E $@456 Li 7 f/&l#§QYy§.%%¤»· H W
, ,— ;Z’“‘* _,,,€,»,’2"’@‘*°; fz ,7:, ig? .M,/mwy»
édé ¢zuL ¢&az¢/zi .4zQuyLzfz,p, %z¢CA,-¢x7,/7,¢.¢¢u¢ -4%*-M=·»;’
?¢66§•VM»Z4’/¢/Z€J%»Z%¢,¢¢»Zumb@,‘;4f,h·¢ém/f4U,4¢jgd-
mu J,4.,.¢I¢."¢0 ./>4z>»·»<. mia ,4.M¢w¤,4,e,»//»ye#2?/颢,e» j
gm t _ / . S ( at E
&M~· %‘“"·"7/ E
¥,,4,,,M,;fL,¢,J»·»¢»=¤¤¤»<*>€¢»
¢é»/"/7z,¢,%u¤/a454zA»
.4*/-·.#2,¢;¢7él7¢7*0¢¢,/¢a.¢444c»·¤¢7é [|
{JZ/‘21’·¢/..»¢0'Aqy`
;z¤4¢.,é¤lj¤,e,4é£;//?%,/p/-4,i; vé ¤7·;;—»¢ y
*2%% A fig; _!/éMw__
flyx mgm ¢»¢»¢·‘L#;···¢&·‘—· E
Mz · @4;; m,,,.(d,,C;,(-_ 4/Mah;/£~¤»·=A~¢»¢» Q
’éâ€'€· Z`·$·? QJ %4¢¢
Jydzzaé %.¢,·.,4,,;A»,{;¢.,¢,»,z,,A»~»{;·»<-
I / A
;?4,£g&fm;A,,?¢4by,/4 #’»¢t,A4;,·-hc ~y¢,/y/¢.j,¢,LA,.»g wm... ____y
1 ‘ . , Qase 3:03-cv-01016-jBA Document 82-4 Filed O3%O252005 Page30f4 H · §
{ ` ( I - I , I n \_ h l
/Q’¢Z;"§Z;g;,@“M’°,Q;`>é;,%/f€’;j,’ A
1 .4¢»éz4>" dz:/2.2 5;; A7L£7;'{9/6 )’
£¢£é..·<. Q`, *522
( _;-/¤y,¢~? %f,;’°;'};,z§, M/;;‘;%z;é M Y
` -¤& Mw. pa. · h.
Q ¢»—»- »/Xzléy M2 .;{â€â€'£‘
cé.».·..=*/2/ ` '
#/7/ /, 79 wélé M.
, »‘·'“·" yy éw¤;¤~¢ ¢¢¢z/uC,7·M,,,
mA"""""‘“’··’é‘ ~‘*"’;fj;_"¢£¢4’~Z°¤)éf¢4»& /¢¢yé#¤»¢·<4¤ /{iz/zz Y
I 4 K _ _ - { {9 . Y
e /%¢. /14.¢2’,Jw—¢%-_ Zappa
/4% /7’9§;*(<~/if/»J·¤#%. @4aL*/ixpéwo l
f¢¢‘rfA"€.€, 4/Zâ€.7¢%47‘, dm; i
/é"7Lâ€"·_;â€z" â€â€œ%/€?é<~ me, Jgékmép N
·%"¢·†····4¢·<»-»<»~·/?%/M7*/¢4»—4»M,Q,¢. mj gL»dé,* &
#24 .1 ." · /;:4, ;,z,;éM A if
g/Z ,4%,4, gw j,(,j—Q,Q "i“j,_,“i,â€gZ_
¢¢¤x4<774»_;¢/»¢,ée.?¢yz¢»¢. img./. gg,
,Z¢¢/q:47¤-;’£·/Z?£·¢%4¢¢»¤°?/7/
i /:44 4T ‘ R
44/2:. ,@@»6%~,Z442é" M;,g¢79
¤¢ -&*¤¤V¤‘Z~
& %£’(··%& A a -4z»M¢7_ " ``` `4¢’¢’4 % ./~¢ _,z¢;}cd6,?/m /7¢¢·¢M¢·¢6/£i;7€¢-?2j
..j%..L.....> 5 ;"""" H ‘ " """ ""’
` ·. .qaS€ 3;0f$ <(;1Ci¤?b&)/0cZm Fueg 0i{>j20 4
Juz2*;4»d¤é,AM2; . Mid %.M;../,26 ,
d¢¢c¢4,4h_; " ` Q ` . ¥
47 v , ;
. ?
. `. r ., H .. _. ` .... . A..... -... ......., .. ...... . .... -. .... ..... . ..,. - .... `.- ...-. ..`` - .... .. .... -... ....m ..... - .... .`... ,4
. .. ....... . 5
J’