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SUPPLEMENT REPORT V/ <br /> Agency Name: Rl Add'I ase umber., <br /> CENTENNIAL LAKES POLICE DPT.EMN0020300 JCF; ❑ Pages: ❑ 14126794 <br /> p Reporting Officer(s). <br /> U- G309 FREDRICKSON,LUCAS Total Value Stolen(Pwperty): $0.00 <br /> Z <br /> ZateReported: Assigned: Arrived: Cleared: <br /> LU Total Value Damaged(Proverty); <br /> 0 Earliest Date imp Occurred: Latest Date Mme Occurred: <br /> V Total Value Recovered(Property): $0.00 <br /> Z <br /> Location of nse/Incident: Apt,; rid: <br /> MOC Code: Classification: Disposition: <br /> W <br /> V <br /> rrW^ <br /> v! <br /> Z <br /> W <br /> U. <br /> U. <br /> O <br /> Incident Narrative 1 <br /> FOLLOW UP- <br /> ON 06-28-2014 AT 1006 HOURS, I CONDUCTED A FOLLOW UP AT 6994 CENTERVILLE ROAD,AFTER A 10-DAY <br /> LU QUARANTINE PERIOD ENDED ON A DOG BITE. <br /> UPON ARRIVAL, I MET WITH STEPHANIE HASIAK. I EXPLAINED TO HASIAK SZARYK WOULD BE LISTED AS <br /> POTENTIALLY DANGEROUS, EXPLAINED THE REQUIREMENTS TO HER,AND THE APPEAL PROCESS. <br /> Z HASIAK AGREED TO ALL THE REQUIREMENTS, SAID SHE WOULD FAX OVER A COPY OF SZARYK'S <br /> MICROCHIP INFO ON MONDAY(06-30-2014),AND FIGURE OUT WHEN SHE WOULD BE ABLE TO <br /> PERMANENTLY AFFIX THE FRONT DRIVEWAY WITH A GATE. <br /> POTENTIALLY DANGEROUS DOG FORM GIVEN TO HASIAK,AND QUARANTINE FORM FILLED OUT. <br /> NAME CODES A-Adult Arrested, AC-Arresting Citizen, C-Complainant, D-Driver, F-Family/Parent, G-Guardian, J-Juvenile Arrested, <br /> M-Mentioned,MP-Missing Person, 1-Other Involved, 0-Owner, P-Passenger, PT-Perpetrator, R-Reportee, S-Suspect, V-Victim, W-Witness <br /> ❑Person A/J/ e: arae: Alias: <br /> ❑Business <br /> Address(Street,City,State,zip): Apt.: Date of Birth: Sex: rar— <br /> r <br /> ight: eight: Hair Color. ye Color: me/Bus.Phone: us. I: U ager ax: <br /> PersonJIU: ode: Name*. Alias: <br /> N ❑Business <br /> W Address(Street.City,State, rp): Apt.: Date ofBirth: Sex: ace: <br /> 2 <br /> Q <br /> Z I Height: eight: Hair Color Eye Color. Hom Bus. e: Wo us.Cell: ager ax: <br /> ❑Person J/U- Code: Name: Atlas: <br /> ❑Business I j <br /> Address(Street,City,State, ip Apt.: Date of Birth: Sex: ace: <br /> Height: eight: Hair Color. Eye Color HomeBus7 one: o us.Call: Cel agedFax: <br /> Nrrvieff., yo: elated se umber. <br /> UIF) - 7 <br /> Pagel 02 <br />