1.

TYPE

OFFENSE/INCIDENT REPORT
INSTRUCTIONS ARE PRINTED SEPARATELY. IF ADDITIONAL SPACE
IS NEEDED, USE REVERSE OF FORM; IDENTIFY ITEMS.
2. CODE NO.

2a. SORT

a. ORIGINAL

b. CONTINUATION

3. TYPE OF OFFENSE OR INCIDENT

c. SUPPLEMENT
OR FOLLOWUP

4. CASE CONTROL NUMBER

murder

4656-613

5. BUILDING NUMBER

6. ADDRESS

7. NAME OF AGENCY/BUREAU

8. AGENCY/BUREAU CODE

5469 east druggie ave.

Atlanta

9. SPECIFIC LOCATION

5555

11a. DATE OF OFFENSE/INCIDENT

11a. TIME OF OFFENSE/INCIDENT

5/30/16

10. LOCATION CODE

Johns home
murder

5556

12.
DAY

13a. DATE REPORTED

13b. TIME REPORTED

6/1/16

9:45

14. DAY

30th

30t
h
15. JURISDICTION (X)

INVOLVED 18. PERSONS

EXCLUSIVE

ID
CODE
(a)

16. NO. OF DEMONSTRATORS

CONCURRENT

PARTIAL

PROPRIETARY

17. NO.
EVACUATED
0

NAME AND ADDRESS

(b)

SE
X
(d)

25

555

TELEPHONE
(g)
HOME

BUSINESS

HOME

Number, Street, Apt. No., City and State

BUSINESS

19. VEHICLE

b.
YEAR

a. STATUS

c. MAKE

STOLEN

GOVT

PERSONAL

VANDALIZ
ED

RECOVERED

e. COLOR (Top/Bottom)

f. IDENTIFYING CHARACTERISTICS

SUSPECT
g.
REGISTRATIO
N

d.
MOD
EL

YEAR

wh
ite

INJURY
CODE
(f)

around
9:00 pm

5469 east druggie street, Atlanta, Georgia

Last Name, First, Middle Initial

RA
CE
(e)

b. TIME END

Number, Street, Apt. No., City and State

TAKEN 20. ITEMS

AGE
(c)

Last Name, First, Middle Initial

Wallus, John, wayne

a. TIME START
around
7:00 pm

STAT
E

TAG
NO.

h. VIN

i. VALUE

a. NAME OF ITEM

b. QUANTITY

e. SERIAL NO.

f. COLOR

g. MODEL

GOVT

h. VALUE

i. UNUSUAL OR UNIQUE FEATURES

j. PROPERTY WAS

k. STATUS OF PROPERTY

SECURRED
UNSECURED

RECOVERED

c. OWNERSHIP

MISSING

PERSONAL

d. BRAND NAME

VALUE RECOVERED

PARTIAL RECOVERY

l. NAME OF ITEM

m. QUANTITY

p. SERIAL NO.

q. COLOR

r. MODEL

GOVT

s. VALUE

t. UNUSUAL OR UNIQUE FEATURES

u. PROPERTY WAS

v. STATUS OF PROPERTY

SECURRED
UNSECURED

RECOVERED

n. OWNERSHIP

MISSING

PERSONAL

PARTIAL RECOVERY

o. BRAND NAME

VALUE RECOVERED

21. NARRATIVE (If additional space is needed, use blank sheet and attach.)

GSA FORM 3155 (REV. 3/200)

GENERAL SERVICES ADMINISTRATION

23a. EVIDENCE

TIME

22. NOTIFICATION

NOTIFIED

YES

ARRIVED

a. Other Police
Agency

b. Fire Department

c. Ambulance

NO

23b. TAG NO.

23c. TYPE

23d. WHERE STORED

24. ATTACHMENTS (Mark X where applicable)

a. CONTINUATION SHEET

b. GSA FORM 3157

c. PROPERTY RECEIPT(S)

e. SUPPLEMENTAL

e. OTHER (Specify)

25. SUSPECT STATUS

26. DISPOSITION OF SUSPECT

a. NOT IDENTIFIED

a. ARRESTED

b. GOVERNMENT EMPLOYEE
c. GOVERNMENT CONTRACT

c. RELEASED

d. NON-GOVERNMENT EMPLOYEE

d. STATEMENT(S)

f. OTHER ATTACHMENTS (Specify)

d. Building Manager

b. NOT ARRESTED

d. N/A

CITATION NUMBER

d. CITATION ISSUED

e. N/A

NOTE: Complete GSA Form 3157 where this is a Suspect, Att. Burglary, Burglary, Att. Robbery, Robbery, or a Weapon is used.
27. TIME
a. RECEIVED

28. REVIEWED BY

b. ARRIVED

a. TYPE
FPS

c. RETURNED TO SERVICE
29a. BADGE

b. SIGNATURE

d. DATE

c. NAME (Printed)

GG

29b. NAME (Printed)

29c. SIGNATURE

29d. DATE

30. CASE REFERRED TO

a. FPS
DETECTIVE

b. LOCAL
POLICE

d. FBI

e. IG

31. CASE

c. STATE POLICE

32. APPROVING OFFICIAL

a. SIGNATURE

a. OPEN

g. OTHER (Specify)

b. CLOSED

c. NAME (Printed)

c. UNFOUNDED

f. N/A

b. DATE

33. DETECTIVE STATUS

a. CASE NUMBER

b. HOW CLOSED
INACTIVE
MEANS

c. SUSPECT
ARREST

OTHER

f. VALUE OF PROPERTY
e. PROPERTY
RECOVERED

d. ENTERED NCIC

DEVELOPED

ARRESTED

g. CLEARED NCIC

YES
h. REFERRED TO

YES

NO

N/A

i. DATE REFERRAL ACCEPTED

21. NARRATIVE (If additional space is needed, use blank sheet and attach.)

NO

N/A

GSA FORM 3155 (REV. 3/200) PAGE 2