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TACTICAL RESPONSE REPORT/Chicago Police Department 1. DATE OF INCIDENT TIME 2. ADDRESS OF OCCURRENCE 3. LOCATION CODE 4. BEAT/OCCUR 14-DEC-2015 01:11:00 1235 S KOSTNER AVE CHICAGO, IL 60623 304 1011 D 5. POSITION 6. LAST NAME 7. FIRST NAME 8. STAR NO. 9. SEX 10. RACE CODE11. AGE 12. HT. 13. WT. RE EV 9161 ZAYAS ALBERTO H 10661 01 M 02 F S 505 168 BL MO 14. DATE OF APPT. 15. EMPLOYEE NO. 16. UNIT & BEAT OF ASSIGNMENT 17. DUTY STATUS 18. MEMBER INJURED? 19. MEMBER IN UNIFORM? MENV 05-DEC-2005 010 1012R 01 On 02 Off 01 Yes 02 No 01 Yes 02 No I 20. LAST NAME 21. FIRST NAME 22. M.I. 23. SEX 24. RACE 25. D.O.B. 26. HT. 27. WT. DNA LEE KENNETH R 01 M 02 F BLK 05-JAN-1982 507 175 N O 28. ADDRESS 1696 E SPRUCE ST KANKAKEE, IL 29. TELEPHONE NO. 30. WAS SUBJECT ARMED?F EET, 31. SUBJECT INJURED? 32. SUBJECT ALLEGED INJURY? TATI 60901 01 Yes 02 No HANDS/FISTS 01 Yes 02 No 01 Yes 02 No CM ER 33. WHERE WAS MEDICAL TREATMENT OBTAINED? 34. BY WHOM? 35. CONDITION 01 Apparently Normal 02 Under Influence UBJFO ST ANTHONY DE PADUA HOSPITAL DR PITZELE 03 Hospitalized 04 Not Hospitalized 05 Refused Medical Aid SIN 36. CHARGES PLACED DNA 37. CB NO. IR NO. DNA **************************** PLEASE SEE NEXT PAGE *************************************** 19236436 38. PASSIVE RESISTER ACTIVE RESISTER ASSAILANT:ASSAULT ASSAILANT:BATTERY ASSAILANT:DEADLY FORCE FORCEDNA SUBJECT'SACTIONS ODVS(DETTIDEIHRF ANEBFDROAE WL NTS EDEWFDIOIRGU LENHLCGTOT) WAIORNMS FPOLUTELHDLEERD A W A Y IOOMFTM HBIENARET NT ET R T Y H R E A T OAAWTTTETTHAAAEPCCROKK N WW II TT HH O W U ETAPON OUCGWTSAREHEUEAESSAPR ETFO O DBN ROE CAD TEI L H Y L IO KH REA L R Y M T O F Oy) MEMBER PRESENCE OPEN HAND STRIKE ELBOW STRIKE KNEE STRIKE FIREARM E pl VERBAL COMMANDS TAKE DOWN / EMERGENCY ASON FOR USeck all that ap MEMBER'SRESPONSE EWAPCSRRORCMENISOSBTTSRARLUTROO RHLCE OKIN SLSDETNSRSUITMIVEEN TAREAS HOCTTAAAACSSNN CEEDINHRRCEE U((MCPFroIFoCnIbANtaeLGc D tW iSsEtcuAhnaP)rOgeN) CSI(MDTLePORsAIScKCrEiEbTD/e PW HiUnEAN BANCoPDHxO 4N0) KI(MDICePsKAcSCribTe M inU NBoITxI O40N) OTHER RE(Ch OWC/A/CUHTEHMOIRCIAZAL TWIOENAPON OTATSHEERR ( S p a r k D i s played) OTHER OTHER 39. * OC/CHEMICAL WEAPON AUTHORIZED BY (NAME) 40. ADDITIONAL INFORMATION DNA POSITION STAR NO. UNIT T N DE 41. WEAPON TYPE 04 SEMI-AUTO PISTOL 42. INCIDENT OCCURRED 43. LIGHTING CONDITIONS 01 Daylight 44. WEATHER CONDITIONS CI 01 REVOLVER 05 CHEMICAL WEAPON Indoors Outdoors 02 Night 03 Dawn 04 Dusk RAIN N 05 Poor Artificial 06 Good Artificial E I 02 RIFLE 06 TASER (Probe Discharge) G 45. MAKE/MANUFACTURER 46. MODEL 47. BARREL LENGTH 48. CALIBER/GAUGE R 03 SHOTGUN 07 OTHER A H C 49. TASER DART ID NO. 50. WEAPON SERIAL No. (Include Letters) 51. CHICAGO GUN REG. NO. 52. IL FIREARM OWNER ID. NO. 53. HANDGUN CERTIFICATE NO. S C6200APC1 X30001DCN DI N 54. SPECIAL WEAPON CERTIFICATE NO. 55. PROPERTY INVENTORY NO. 56. TYPE OF AMMUNITION USED 57.NO. OF WEAPONS DISCHARGED BY 58. TOTAL NO. OF SHOTS MEMBER O THIS MEMBER. 1 FIRED P A WE 59. WHO FIRED FIRST SHOT 03 OTHER (SPECIFY) 6D0U. RWINAGS IFNIRCEIDAERNMT RELOADED 6S1H.O NTO S OHFE LCLASRTRIDGES/ 62. HOW WAS MEMBER'S HANDGUN WORN 03 OTHER (Specify) 1 70. E 01 MEMBER 02 OFFENDER 01 YES 02 NO RELOADED 01 RT. SIDE (WAIST) 02 LT. SIDE (WAIST) 5 VE 63. HOW WAS MEMBER'S HANDGUN DRAWN 03 OTHER (Specify) 64. SPECIFY METHOD/EQUIPMENT USED TO RELOAD 65. DID MEMBER USE SIGHTS 34 NT NO 01 STRONG SIDE DRAW 02 CROSS DRAW 01 YES 02 NO 8 . 0 66. DESCRIBE PROTECTIVE COVER USED (LIGHT POLES, DOORWAYS, CAR, FURNITURE, ETC) 67. DISTANCE BETWEEN INVOLVED MEMBER & OFFENDER WHEN FIRST SHOT WAS FIRED 0 01 0 - 05 FT. 02 05 - 10 FT. 03 10 - 15 FT. 04 OVER 15 FT. 4 9 68. PERSON/OBJECT STRUCK AS RESULT OF THE DISCHARGE OF MEMBERS WEAPON 69. POSITION OF MEMBER DISCHARGING WEAPON 01 STANDING 02 LYING DOWN 7 01 PERSON 02 OBJECT 03 BOTH 04 UNKNOWN 03 SITTING 04 KNEELING 05 OTHER (SPECIFY) 72. NOTIFICATIONS (OC OR TASER INCIDENT): OEMC DSS & LT./DIST. OF OCCUR. CPIC 71. R CASEINFO. NMOeTmIFbIeCrAsT wIOilNl eSn (sFuIRreE AthRaMt aINllC rIeDqEuNirTe)d: notifications aOnEdM aCll witnessDeSsS t/oD ItShTis. uOsFe O oCf CfoUrRc e& aOreC IdCocumented inC tPhIeC appropiate DcaEsTe. DreIVp.ort. HY .D. NO. 5 73. REPORTING MEMBER (Print Name) STAR/EMPLOYEE NO. SIGNATURE 3 S ZAYAS, ALBERTO H 10661 6 E 14-DEC-2015 03:38:36 2 R 4 U T Reviewing supervisor will ensure the legibility and completeness of this report and attest by entering the required information below. 9 A N G 74. REVIEWING SUPERVISOR (Print Name) STAR NO. SIGNATURE DATE REVIEWED TIME SI ORTEGA, ELVIS 1092 14-DEC-2015 04:29:28 CPD-11.377 (REV. 3/08) N 36. CHARGES PLACED DNA O 625 ILCS 5.0/6-303-A, 625 ILCS 5.0/11-1402-A, 625 ILCS 5.0/12-603.1, 625 ILCS TI 5.0/3-707, 720 ILCS 550.0/4-D, 720 ILCS 570.0/402-C, 625 ILCS 5.0/6-303-A, 720 TA CM ILCS 5.0/31-1-A, 720 ILCS 5.0/31-1-A, 720 ILCS 570.0/402-C, 720 ILCS 5.0/12- BJEOR 3.05-D-4, 720 ILCS 5.0/12-3.05-D-4 UF SN I LIEUTENANT OR ABOVE/OCIC REVIEW THE ON-CALL INCIDENT COMMANDER (OCIC) WILL COMPLETE THE REVIEW SECTION FOR 1.) ALL INCIDENTS INVOLVING THE DISCHARGE OF A FIREARM BY A DEPARTMENT MEMBER; 2.) ALL INCIDENTS INVOLVING THE SERIOUS INJURY OR DEATH OF A MEMBER OF THE PUBLIC SUBSEQUENT TO INTERACTIONS WITH A DEPARTMENT MEMBER; 3.) ALL INCIDENTS INVOLVING THE DISCHARGE OF IMPACT MUNITIONS BY A DEPARTMENT MEMBER; 4.) ANY LESSER USE OF FORCE BY A DEPARTMENT MEMBER WHEN THAT USE OF FORCE STEMS FROM THE SAME INCIDENT DESCRIBED HERE IN 1 THROUGH 3. THE ASSIGNED INVESTIGATING SUPERVISOR THE RANK OF LIEUTENANT OR ABOVE FROM THE DISTRICT OF OCCURRENCE WILL COMPLETE THE REVIEW SECTION FOR ALL OTHER INCIDENTS. 75. SUBJECT'S STATEMENT REGARDING THE USE OF FORCE DNA REFUSED INTERVIEW NOT CONDUCTED (Specify Reason) At St. Anthony Hospital 76. LIEUTENANT OR ABOVE/OCIC RATIONALE FOR BOX 77 FINDING The officers were attempting to control an assailant who was attempting to strike them and who was pulling away. Force necessary to control and to effect the arrest of this subject was used including Taser probe discharge. These actions are in compliance with Department procedures and directives. 77. LIEUTENANT OR ABOVE/OCIC FINDING BASED UPON CURRENTLY AVAILABLE INFORMATION: I HAVE CONCLUDED THAT THE MEMBER'S ACTIONS I HAVE CONCLUDED THAT FURTHER INVESTIGATION IS REQUIRED. WERE IN COMPLIANCE WITH DEPARTMENT PROCEDURES AND DIRECTIVES. LOG NO./CRNO. OBTAINED 78. LIEUTENANT OR ABOVE/OCIC (Print Name) SIGNATURE DATE COMPLETED TIME PEABODY, ROBERT J 14-DEC-2015 04:41:43 79. TOTAL TRR's THIS EVENT No. 2