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ARREST / NOTICE TO APPEAR
Juvenile Referral Report
ADMINISTRATIVE
OBTS Number
Agency ORI Number: FLO500600
Agency Name: PALM BEACH POLICE DEPARTMENT
Charge Type Check as many as apply: 3. Misdemeanor
Location of Arrest (Including Name of Business): 200 Block BAHAMA LANE
Date of Arrest: 09/11/05
Time of Arrest: 23:54
Booking Date:
Booking Time:
Jail Date:
Jail Time:
1. Arrest 2. NTA 3. Request for Warrant 4. Request for Capias
Agency Report Number (N.T.A.'s only): H05-H0012631110211
Weapon Seized
Enter Type
Multiple Clearance Indicator
Location of Offenses (Business Name, Address)
200 Block BAHAMA LANE
Location of Vehicle
CO-DEF.
Co-Defendant Name (Last, First, Middle): SALLER, BRYAN BENJAMIN
Race: W
Sex: M
Date of Birth: 12/29/86
1. Arrested 2. At Large
3. Felony 4. Misdemeanor 5. Juvenile
Co-Defendant Name (Last, First, Middle):
Race:
Sex:
Date of Birth:
1. Arrested 2. At Large
3. Felony 4. Misdemeanor 5. Juvenile
JUVENILE
Name (Last) (First) (Middle)
Residence Phone
Legal Custodian
Address (Street, Apt. Number) (City) (State) (Zip)
Business Phone
Parent
Legal Custodian
Other:
Name (Last)
Address (Street, Apt. Number)
Date
Time
TOT JAC
School Attended
Grade
The above address was provided by defendant and/or defendant's parents. The child and/or parent was told to keep the Juvenile Court Clerk's Office (Phone 355-2526) informed of any change of address.
Yes, by: (Name)
No: (Reason)
Property Crime? Yes No
Description of Property
Value of Property
CHARGE
Charge Description: POSSESSION of MARIJUANA
Drug Activity: P - Possess
Drug Type: M
Amount/Unit: UNDER 20 Gms
Offense #: 05/1263
Counts: 1
Domestic Violence: N
Statute Violation Number: 893.13.1(6)(B)
Violation of ORD #
Bond
CHARGE
Charge Description: DRUG PARAPHERNALIA - POSSESS
Drug Activity: P - Possess
Drug Type: P.C.
Amount/Unit: PIPE
Offense #: 05/1263
Counts: 1
Domestic Violence: N
Statute Violation Number: 893.147.111
Violation of ORD #
Bond
CHARGE
Charge Description:
Drug Activity:
Drug Type:
Amount/Unit:
Offense #:
Counts:
Domestic Violence: Y N
Statute Violation Number:
Warrant / Capias Number:
Violation of ORD #
Bond
CHARGE
Charge Description:
Drug Activity:
Drug Type:
Amount/Unit:
Offense #:
Counts:
Domestic Violence: Y N
Statute Violation Number:
Warrant / Capias Number:
Violation of ORD #
Bond
NOTICE TO APPEAR
Instruction No. 1 Mandatory Appearance in Court
Instruction No. 2 You need not appear in Court but must comply with instructions on Reverse Side.
Location (Court, Room Number, Address): 3228 GUN CLUB ROAD WEST PALM BEACH FL
Court Date and Time: Month SEPTEMBER Day 27 Year:
Time: 0800 A.M.
I AGREE TO APPEAR AT THE TIME AND PLACE DESIGNATED TO ANSWER THE OFFENSE CHARGED OR TO PAY THE FINE SUBSCRIBED. I UNDERSTAND THAT SHOULD I WILLFULLY FAIL TO APPEAR BEFORE THE COURT AS REQUIRED BY THIS NOTICE TO APPEAR, THAT I MAY BE HELD IN CONTEMPT OF COURT AND A WARRANT FOR MY ARREST SHALL BE ISSUED.
Date Signed: 9/11/05
Signature of Defendant or Juvenile and Parent / Custodian
Signature of Arresting Officer: [Signature]
Name of Arresting Officer (Print): OFC NICHOLAS CARISTO
I.D. #: 8801
Agency: PBPD
Name Verification (Printed by Arrestee)
ADMIN.
HOLD for other Agency
Name:
Dangerous
Suicidal
Resisted Arrest
Other:
Intake Deputy
I.D. #
Youth
Transporting Officer
I.D. #
Agency
Witness here if subject signed with an "X"
PAGE OF
DISTRIBUTION: WHITE - COURT COPY GREEN - STATE ATTORNEY YELLOW - AGENCY PINK - JAIL GOLD - DEFENDANT (N.T.A.'s ONLY)
07/26/17
Page 59 of 111
Public Records Request No.: 17-295
DOJ-OGR-00031469