Transcription of STATE OF NEW JERSEY • DEPARTMENT OF LAW & PUBLIC …
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STATE OF NEW JERSEY • DEPARTMENT OF LAW & PUBLIC …
This report should be submitted immediately upon completion, DO NOT wait for the end of the month to (Rev. 08/18) STATE OF NEW JERSEY DEPARTMENT OF LAW & PUBLIC safety Supplementary Domestic Violence Offense ReportPlease enter the information on this form into the UCR System and forward a copy to your Municipal/Superior Case Number2. Municipality3. Mun. Code4. STATE Police Station (NJSP Use Only)5. Code6. DEPARTMENT 's Telephone (incl. Area Code)Extension7. Date of Offense8. Day CodeSuMTuWThFSa9. Time (Military)10. Total Time (Hrs:Mins)11. Was Alcohol Involved?12. Were Other Drugs Involved?YESYES20. Relationship of Victim to Offender at the time of Incident (Check ONLY ONE) Victim Was:MaleFemaleW - WhiteA - AsianB - Black/African AmericanP - Native Hawaiian/Other Pacific IslanderI - American Indian/Alaska NativeU - UnknownA - HispanicB - Non-HispanicYESYESYESP sychologicalPhysicalYESPRESENTI nvolvedNot InvolvedYESNOS pouseEx-SpouseBoyfriend/GirlfriendEx-boy friend/Ex-girlfriendCommon-Law SpouseChildStepchildChild of Boy/GirlfriendParentStepparentSiblingSte p-SiblingIn-LawGrandparentGrandchildOthe r Family MemberFriendAcquaintanceOffenderHomosexu al RelationshipVICTIM I
STATE OF NEW JERSEY • DEPARTMENT OF LAW & PUBLIC SAFETY . Supplementary Domestic Violence Offense Report. ... Handgun Rifle Shotgun Other Firearm Knife/Cutting Instrument (knives, razors, hatchets, axes, cleavers, scissors, glass, broken bottles, ice picks, etc.) Blunt Object
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