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Attachment A ROSE VIL L E POL ICE DEPA R TMEN T INCIDENTREPORT ICR# 11027913 1 AGENCY ORI# MN0620800 I JUVENILE: Reported: 09-27-2011 1822 First Assigned:1 822 First Arrived:1 822 Last Cleared: 1900 z I W Comm iced Start: 09-27-2011 1808 Comm iced End: 09-27'-2011 1810 a 0 Title: Alcohol Violations How Received: None Selected z Short Description: Alcohol Compliance check failed. See Report to be completed this week at completion of checks. Summary: On Sale Alcohol Violation- Serve alcohol to person under 21. Report will be completed this week. Location(s) The Courtyard By Marriot Address: 2905 CENTRE POINTE DR City: Roseville State: MN Zip: 55113 cf) Officer Assigned: Johnson, Sean Badge No: S-1 9 Primary: Yes W Lu Dt/tm Assigned: -- Time Arrived: Time Cleared: 0 U. W 0 0 1 MOC: M4102 Literal: LIQUOR - SELLING Statute: 340A-401 UCR: 22 0 2 C0 W z Involvement: Cited Name: Gutz, Patricia Ann DOB: Age: Sex: Race: Height: Weight: Address: 10211 Isetta St City: CIRCLE PINES State: SIN Zip: 55014 Phone: (Cell) (763)516-1491 Phone: (Business) (651)746-8000 ID Number(s) ID Type: DL / ID Number ID #: State: SIN Year: Class: D Involvement: Other Name: DOB: Age: Sex: Race: Height: Weight: Address: 10035 RUSSELL AVE N City: BROOKLYN PARK State: SIN Zip: 55444 Phone: (Home) (612)987-6682 Phone: (Work) (651)367-2032 Phone: (Business) (651)746-8000 Eye Color: Hair Color: ID Number(s) ID Type: DL / ID Number ID #: State: Year: Class: D Involvement: Other Name: XXXXXXXXXXXX XXXXXXXX XXXXXX DOB: XX -XX -1991 Age: 20 Sex: M Race: Height: XXX Weight: XXX Address: XXXX XXXXX XX City: XXXXXXXXX State: XX Zip: XXXXX Phone: XXXXXX XXXXXXXXXXXXX Eye Color: XXX Hair Color: ID Number(s) ID Type: DL / II D Number I D #: XXXXXXXXXXXXX Involvement: Mentioned Name: Harris, Alan Age: Sex: Race: State: Year: Class: X DOB: -- Height: 0 Weight: 0