I
N
C
I
D
E
N
T
D
A
T
A
Agency Name
INCIDENT/INVESTIGATION
REPORT
FORSYTH COUNTY SHERIFF`S
NC 0340000
Crime Incident(s)
Robbery
#2
Crime Incident
#3
Crime Incident
How Attacked or Committed
MO
V
I
C
T
I
M
Forcible
X Yes
No
Three Armed Suspect Entered Business And Demanded Money From Victim
# of Victims Type X Person
Business
Society
Government
Financial Institute
3
L.E. Officer Line of Duty
Other/Unknown
Religious
Victim/Business Name (Last, First, Middle)
V1
Injury
ROBERTSON, ZACHARY ALEXANDER
Home Address
O
T
H
E
R
S
Make
Model
Style
Color
Lic/Lis
P
R
O
P
E
R
T
Y
V2
Vin
THE DEPOT GAMING CENTER,
Home Phone
Business Phone
Type: X Person
Business
Society
Code Name (Last, First, Middle)
V3
Government
Financial Institute
Religious
COFFEY, SANDRA KARI
Mobile Phone
L.E. Officer Line of Duty
Other/Unknown
Victim of DOB / Age
Crime #
Status
DCI-600F
Race Sex
Home Phone
Business Phone
L = Lost S = Stolen R = Recovered D = Damaged Z = Seized B = Burned C = Counterfeit / Forged
(Check "OJ" column if recovered for other jurisdiction)
Victim
DCI Status
Value
OJ
QTY
Property Description
#
2
61
S
$3,226.00
1 US CURRENCY
3
65
S
$60.00
1 PURSE
3
65
S
$20.00
1 WALLET
3
65
S
$20.00
1 HAND BAG
3
64
S
$1.00
1 PREPAID DEBIT CARD
3
99
S
$1.00
1 SOCIAL SECURITY CARD
3
99
S
$5.00
1 KEYS
3
13
S
$150.00
1 MAKE UP
3
61
S
$300.00
15 US CURRENCY
3
99
S
$1.00
1 DRIVERS LICENSE
PITTMAN, J. R. (2030)
33
Home Address
Complainant Signature
Race Sex
1,
Home Address
Number of Vehicles Stolen
Officer
ID
Mobile Phone
CODES: V- Victim (Denote V2, V3) O = Owner (if other than victim)
R = Reporting Person (if other than victim)
Type:
Person X Business
Society
Government
Financial Institute
Religious
L.E. Officer Line of Duty
Other/Unknown
Victim of DOB / Age
Code Name (Last, First, Middle)
Crime #
Employer Name/Address
Status
Codes
Handgun
Business Phone
Employer Name/Address
I
N
V
O
L
V
E
D
Weapon / Tools
N/A
Drug/Alcohol Use:
Minor
Loss of Teeth
X None
Broken Bones
Yes
Unknown
Severe Lacerations
Unconscious
Other Major
Internal
N/A
X No
Victim of DOB / Age
Race Sex Relationship Resident Status
To Offender X Resident
Crime #
25
Non-Resident
1,
W M ST
Unknown
Home Phone
Employer Name/Address
VYR
201603965
Date / Time Reported S M T =W T F S
Month
Day
Yr
Time
05
04 2016 00:35 Hrs.
S
M
T
W
T
F
S
S
M
T =W T F S
At Found
Last Known Secure
=
Att
Month Day
Yr
Month Day
Yr
Time
Time
X Com 05
04 2016 00:34 Hrs. 05 04 2016 00:33 Hrs.
Offense Tract
Att Location of Incident
Com 8100-BLK Depot St, Rural Hall NC 27045
ZRH
Victim Residence Type
Att Premise Type
Com OTHER NON-RESIDENTIAL
Single Family Multi Family
ORI
#1
OCA
Number Vehicles Recovered
0
ID#
Officer Signature
Mobile Phone
F = Found
Make/Model
Serial Number
UNKNOWN
USA
ASSORTED
USA/Twenty Dollar B
NC
Total Stolen Value: $3,784.00
Supervisor Signature
Case Status
X Further Investigation
Inactive
Closed/Cleared
Closed/Leads Exhausted
SNYDER, J. R. (1638)
Case Disposition:
Unfounded
Located
Extradition Declined
Cleared by Arrest
Refuse to Cooperate
Cleared by Arrest by Another Agency
Page 1
Death of Offender
Prosecution Declined
Rev.3/92
Incident Report Additional Name List
OCA: 201603965
Forsyth County Sheriff`s Office
Page 2
Additional Name List
NameCode/#
1 ) OW 1
Victim of
Crime #
Name (Last, First, Middle)
DOB
EDWARDS, MICHAEL LOMAN
53
Address
H:
Empl/Addr
B:
Mobile #:
R_CS7NC
Age Race Sex
05/04/2016 12:50
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