HomeMy Public PortalAboutPRR 23-2945
TOWN OF GULF STREAM
PALM BEACH COUNTY, FLORIDA
Delivered via e-mail
June 5, 2023
Art [mail to: amfmanagement@yahoo.com]
Re: GS #2945 (Police Report)
A verbal request for a copy of the police report from June 2, 2023, at 3737 N. Ocean Blvd.,
Gulf Stream FL.
Dear Art [mail to: amfmanagement@yahoo.com]:
The Town of Gulf Stream has received your verbal public records request on June 2, 2023. You
should be able to view the response at the following link:
PRR 23-2945 (laserfiche.com)
We consider this request closed.
Sincerely,
Reneé R. Basel, CMC
Reneé R. Basel, CMC
Town Clerk, Custodian of the Records
AGENCY CASE #
230987
REPORT TIME
2:40 PM
REPORT DATE
06/02/2023
REPORT TYPE
ORIGINAL
OFFENSE-INCIDENT REPORT
GULF STREAM POLICE DEPARTMENT
DATE CLEARED EXCEPTIONALLY
06/02/2023
CLEARED EXCEPTIONALLY
IN CUSTODY - OTHER JURISDICTION
STATUS
CLEARED BY ARREST
TIMETO DATETIMEFROM DATESUPPLEMENT DATE
DAY OF WEEKINCIDENT TIME TO
09:00
INCIDENT DATE TO
06/02/2023
INCIDENT TIME/FROM
08:17
INCIDENT DATE/FROM
06/02/2023
EXACT TIME?
NO
USE OF FORCE
NO
GANG RELATED?
NO
JUVENILE?
NO
DESCRIPTION
BURGLARY RESIDENCE
ORIGINALCASE INFORMATION -
ZONE
4
OFFENSE STRUCTURES
ENTERED QUANTITY 1PASSAGE POINT METHOD
FORCED
AND LONGITUDEAT LATITUDEZIP
33483
STATE
FL
CITY
GULF STREAM
APT/UNIT #STREET CATEGORY CODE
BOULEVARD
POST DIRECTIONSTREET NAME
OCEAN
PRE DIRECTION
NORTH
STREET #
3737
COMPANY NAMEAT BUSINESS?
NO
LOCATION TYPE
RESIDENCE/HOME
VEHICLE
NO
CHILD PRESENT
NONE PRESENT
CARGO THEFT
FALSE
BIAS MOTIVATION FOR HATE CRIMEHATE CRIME
FALSE
ATTEMPTED
COMPLETED
SUSPECTED OF USING
N/A
TYPE OF WEAPON FORCE (UP TO 3)TYPE OF CRIMINAL ACTIVITY(up to 3)
NONE/UNKNOWN
INCREASED PENALTYCOUNTS
1
STATUTE DESCRIPTION
UNOCCUPIED STRUCTURE UNARMED
STATE STATUTE
810.02(4A)
ORDINANCE #CHARGE SEVERITY
FELONY
CHARGE TYPE
FSS
OFFENSE FDLE CODEOFFENSE KNOWN
PENDING
1LOCATION OF OFFENSE
OFFENSE INFORMATION
E-MAILPHONE #PERSON RESIDENCE CODE
NONRESIDENT
ADDRESS SOURCE
ID
ZIP CODE
33037
STATE
FL
CITY
KEY LARGO
APT/UNIT #STREET CATEGORY CODE
HIGHWAY
STREET NAME
OVERSEAS
STREET #
100961
ALT NAME DESC.ALIAS / MAIDEN
SUFFIXLAST NAME
ELLSWORTH
MIDDLE NAME
IVAN
FIRST NAME
DARIN
OCCUPATION
NONE
BUSINESS/GOVERNMENT NAMEIS BUSINESS OR GOV'T?
NO
REPORTED BY?RELATIONSHIP TO SUBJECTTYPE OF WITNESSJUVENILE?
NO
1SUSPECTPERSON -
5of1
AGENCY CASE #
230987
REPORT TIME
2:40 PM
REPORT DATE
06/02/2023
REPORT TYPE
ORIGINAL
OFFENSE-INCIDENT REPORT
GULF STREAM POLICE DEPARTMENT
OTHER ID #DOC #SPN #BOOKING #FCIC/NCIC #FBI #INS #SOC. SEC. #
COUNTRY OF CITIZENSHIP
US - UNITED STATES
PLACE OF BIRTH
US
DL CLASS
E
DL STATE
FL
DRIVER LICENSE #
E426169673430
CLOTHING (Describe)
BLK SHIRT BLK PANTS
SPEECH/VOICETEETHFACIAL HAIRSCARS/MARKS/TATOOS (LOCATION / DESCRIBE)
PHYSICAL FEATURECOMPLEXTION
FAR
BUILD
SLIM
HAIR COLOR
GRY
EYE COLOR
BRO
WEIGHT INDICATORWEIGHT UNKNOWNWEIGHT RANGE MAXWEIGHT RANGE MINWEIGHT
190 LBS
HEIGHT ESTHEIGHT UNKNOWNHEIGHT RANGE MAXHEIGHT RANGE MINHEIGHTETHNICITY UNKNOWNETHNICITY
UNKNOWN
RACE
W
AGE INDICATORAGE MEASURE CODEAGE RANGE MAXAGE RANGE MINAGE
55
DATE OF BIRTH
9/23/1967
GENDER
M
TYPE OF INJURY (UP TO 5)
NONE
FORCE CATEGORYUSE OF FORCE
RESIST CATEGORYRESIST CODE
NO
IMPAIRMENT CODE
NO
IMPAIRMENT CATEGORY
CHARGE(S)
BURGLARY OF RESIDENCE
ARMED
FALSE
THREAT
FALSE
CAUTION INFO
FALSE
VIOLENT CAREER CRIMINAL
FALSE
3 TIME VIOLATOR
FALSE
PRISON RELEASE REOFFENDER
FALSE
HABITUAL
FALSE
HOMELESS
TRUE
MENTAL HEALTH
FALSE
SEXUAL OFFENDER
FALSE
NAME OF GANG(S)GANG INFO (UP TO 2)GANG AFFILIATION
FALSE
PROBATION STATUS
FALSE
ARRESTED
YES
PRESENT WHEN
OFFICER ARRIVED YESTYPE OF OFFENDER
OFFENDER
E-MAILPHONE #
(207) 985-7074
PERSON RESIDENCE CODE
ADDRESS SOURCEZIP CODE
33483
STATE
FL
CITY
GULF STREAM
APT/UNIT #STREET CATEGORY CODE
BOULEVARD
STREET NAME
N OCEAN
STREET #
3737
ALT NAME DESC.ALIAS / MAIDEN
SUFFIXLAST NAME
SMITH
MIDDLE NAMEFIRST NAME
NOEL
OCCUPATIONBUSINESS/GOVERNMENT NAMEIS BUSINESS OR GOV'T?
REPORTED BY?RELATIONSHIP TO SUBJECTTYPE OF WITNESSJUVENILE?
NO
2VICTIMPERSON -
5of2
AGENCY CASE #
230987
REPORT TIME
2:40 PM
REPORT DATE
06/02/2023
REPORT TYPE
ORIGINAL
OFFENSE-INCIDENT REPORT
GULF STREAM POLICE DEPARTMENT
OTHER ID #DOC #SPN #BOOKING #FCIC/NCIC #FBI #INS #SOC. SEC. #
COUNTRY OF CITIZENSHIPPLACE OF BIRTHDL CLASSDL STATEDRIVER LICENSE #
CLOTHING (Describe)
SPEECH/VOICETEETHFACIAL HAIRSCARS/MARKS/TATOOS (LOCATION / DESCRIBE)
PHYSICAL FEATURECOMPLEXTIONBUILD
AVERAGE
HAIR COLOREYE COLORWEIGHT INDICATORWEIGHT UNKNOWNWEIGHT RANGE MAXWEIGHT RANGE MINWEIGHT
HEIGHT ESTHEIGHT UNKNOWNHEIGHT RANGE MAXHEIGHT RANGE MINHEIGHTETHNICITY UNKNOWNETHNICITYRACE
W
AGE INDICATORAGE MEASURE CODEAGE RANGE MAXAGE RANGE MINAGEDATE OF BIRTHGENDER
M
TYPE OF INJURY (UP TO 5)
OFFENSE(S) ASSOCIATION TO VICTIM
AGGRAVATED ASSULTJUSTIFIABLE HOMICIDEVICTIM TO SUBJECT RELATIONSHIPTYPE OF VICTIM
E-MAILPHONE #
(561) 703-0515
PERSON RESIDENCE CODE
NONRESIDENT
ADDRESS SOURCEZIP CODESTATECITY
APT/UNIT #STREET CATEGORY CODESTREET NAMESTREET #
ALT NAME DESC.ALIAS / MAIDEN
SUFFIXLAST NAME
ALLOCCO
MIDDLE NAMEFIRST NAME
MARC
OCCUPATION
PROPERTY MANAGER
BUSINESS/GOVERNMENT NAMEIS BUSINESS OR GOV'T?
NO
REPORTED BY?
YES
RELATIONSHIP TO SUBJECT
NONE
TYPE OF WITNESSJUVENILE?
NO
3VICTIMPERSON -
5of3
AGENCY CASE #
230987
REPORT TIME
2:40 PM
REPORT DATE
06/02/2023
REPORT TYPE
ORIGINAL
OFFENSE-INCIDENT REPORT
GULF STREAM POLICE DEPARTMENT
OTHER ID #DOC #SPN #BOOKING #FCIC/NCIC #FBI #INS #SOC. SEC. #
COUNTRY OF CITIZENSHIPPLACE OF BIRTHDL CLASSDL STATEDRIVER LICENSE #
CLOTHING (Describe)
SPEECH/VOICETEETHFACIAL HAIRSCARS/MARKS/TATOOS (LOCATION / DESCRIBE)
PHYSICAL FEATURECOMPLEXTIONBUILD
HAIR COLOREYE COLORWEIGHT INDICATORWEIGHT UNKNOWNWEIGHT RANGE MAXWEIGHT RANGE MINWEIGHT
HEIGHT ESTHEIGHT UNKNOWNHEIGHT RANGE MAXHEIGHT RANGE MINHEIGHTETHNICITY UNKNOWNETHNICITYRACE
W
AGE INDICATORAGE MEASURE CODEAGE RANGE MAXAGE RANGE MINAGEDATE OF BIRTHGENDER
M
OCCUPATION
PROPERTY MANAGER
PHONE #
(561) 703-0515
ZIP CODE
33483
STATE
FL
CITY
GULF STREAM
APT/UNIT #STREET CATEGORY CODE
BOULEVARD
STREET NAME
N OCEAN
STREET #
3737
BUSINESS ADDRESS
TYPE OF INJURY (UP TO 5)
OFFENSE(S) ASSOCIATION TO VICTIM
AGGRAVATED ASSULTJUSTIFIABLE HOMICIDEVICTIM TO SUBJECT RELATIONSHIP
STRANGER
TYPE OF VICTIM
INDIVIDUAL
OFFICER INFORMATION
SIGNATURE TIME
09:14
SIGNATURE DATE
06/02/2023
OFFICER SIGNATURESIGNATURE METHOD
DIGITAL
RANK
OFFICER
BADGE #LAST NAME
SUTTON
FIRST NAME
TODD
1ADMINISTRATIVE
OBTS #JAIL #ASSIGNED BYASSIGNED TOREFERRED TOROUTED TO
NAME (PRINTED)
SIGNATURE OF PERSON ADMINISTERING OATH
SWORN AND SUBSCRIBED BEFORE ME, THE UNDERSIGNED AUTHORITY THIS _____ DAY OF _______________, 20_____.
TITLE
5of4
AGENCY CASE #
230987
REPORT TIME
2:40 PM
REPORT DATE
06/02/2023
REPORT TYPE
ORIGINAL
OFFENSE-INCIDENT REPORT
GULF STREAM POLICE DEPARTMENT
ON 6/02/23 AT 0817 HOURS CHIEF JONES, CAPT HASELEY, AND I RESPONDED TO 3737 N
OCEAN BLVD IN REFERENCE TO A REPORT OF A SUSPICIOUS INCIDENT. UPON ARRIVAL
CONTACT WAS MADE WITH PROPERTY REPRESENTATIVE MARC ALLOCCO WHO ADVISED
THERE WAS AN UNKNOWN SUBJECT INSIDE THE CABANA HOUSE TO THE REAR OF THE
PROPERTY. UPON GAINING ACCESS, DARIN ELLSWORTH WAS FOUND SLEEPING ON THE
FLOOR UNDER STACKED PATIO FURNITURE. HE ADVISED HE ENTERED THE HOME TO GET
OUT OF THE RAIN. MR ELLSWORTH ENTERED THE HOME BY BREAKING AN EAST SIDE
WINDOW AND UNLOCKING IT, THEN CLIMBING THROUGH. PHOTOS TAKEN. NO OTHER
DAMAGE TO THE EXTERIOR OR INTERIOR OF THE HOME WAS REPORTED BY THE
COMPLAINANT. MR ELLSWORTH WAS NOT GIVEN PERMISSION BY ANYONE TO ENTER THE
PROPERTY. HOMEOWNER LINDA HARPER -SMITH (207-468-0287) WAS CONTACTED BY
CHIEF JONES AND ADVISED OF THE INCIDENT. MR ELLSWORTH WAS THEN TRANSPORTED
TO THE GULF STREAM POLICE DEPT. AND THEN TO THE PALM BEACH COUNTY JAIL.A
BODY CAM WAS UTILIZED DURING POLICE RESPONSE TO THIS INCIDENT AND DURING
INTERVIEWS. NO FURTHER.
NARRATIVE
5of5
ARREST AFFIDAVIT
15TH JUDICIAL CIRCUIT
CIRCUIT
GULF STREAM POLICE DEPARTMENT
REPORTING AGENCY
06/02/2023
REPORT DATE
FL0501300
REPORTING AGENCY ORI #
FL0501300
ARRESTING AGENCY ORI #
FL0501300
SUBMITTING AGENCY ORI #
FL0501300
BOOKING AGENCY ORI #
230987
AGENCY CASE #ARREST # OR COURT CASE #
NO
JUVENILE?
ON-VIEW ARREST
TYPE OF ARREST
OBTS #EVIDENCE CONFISCATED EVIDENCE CONFISCATED DESCRIPTION
6. OTHER/CAPIAS5. ORDINANCE4. TRAFFIC MISDEMEANOR3. MISDEMEANOR2. TRAFFIC FELONY1. FELONY
06/02/2023
DATE
08:25 AM
TIME
06/02/2023
DATE
09:00 AM
TIME DATE TIMECASE INFORMATIONJAILBOOKINGARREST
NO
AT BUSINESS?COMPANY NAME
3737
STREET #
NORTH
PRE DIRECTION
OCEAN
STREET NAME POST DIRECTION
BOULEVARD
STREET CATEGORY CODE APT/UNIT #
GULF STREAM
CITY
FL
STATE
33483
ZIP AT LATITUDE AND LONGITUDE
LOCATION OF ARRESTNO
AT BUSINESS?COMPANY NAME
3737
STREET #
NORTH
PRE DIRECTION
OCEAN
STREET NAME POST DIRECTION
BOULEVARD
STREET CATEGORY CODE APT/UNIT #
GULF STREAM
CITY
FL
STATE
33483
ZIP AT LATITUDE AND LONGITUDE
LOCATION OF OFFENSEARRESTEE1
PERSON #COARRESTEE STATUS
NO
JUVENILE?PARENTS CONTACTED?RELATIONSHIP TO SUBJECT
NO
NTA ?
BUSINESS/GOVERNMENT NAME VICTIM TO SUBJECT RELATIONSHIP
DARIN
FIRST NAME
IVAN
MIDDLE NAME
ELLSWORTH
LAST NAME SUFFIX
9/23/1967
DATE OF BIRTH
55
AGE
M
GENDER
6'02"
HEIGHT
W
RACE
UNKNOWN
ETHNICITY ALIAS / MAIDEN ALT NAME DESC.
FAIR
COMPLEXTION
SLIM
BUILD
190 LBS
WEIGHT
BRO
EYE COLOR
GRY
HAIR COLOR PHYSICAL FEATURE
SCARS/MARKS/TATOOS (LOCATION / DESCRIBE)
NONE
DUI INDICATOR
YES
SPEAKS ENGLISH?
NO
THREAT?
NO
PROBATION?
NO
GANG AFF?
NO
SEX OFFENDER?
NO
MENTAL HEALTH
YES
HOMELESS?
E426169673430
DRIVER LICENSE #
FL
DL STATE
E
DL CLASS
US
PLACE OF BIRTH
CITIZENSHIP
455-65-4255
SOC. SEC. #INS #FBI #FCIC/NCIC #BOOKING #SPN #DOC #OTHER ID #
100961
STREET #
OVERSEAS
STREET NAME
HIGHWAY
STREET CATEGORY CODE APT/UNIT #
KEY LARGO
CITY
FL
STATE
33037
ZIP CODE ADDRESS SOURCE
NONRESIDENT
PERSON RESIDENCE CODE PHONE #E-MAIL
PERMANENT ADDRESS
IDENTIFICATION
230987AGENCY CASE #: 06/02/2023REPORT DATE:
PAGE OF
41
1
CHARGE #
1
VICTIM PERSON #
06/02/2023
OFFENSE START DATE
06/02/2023
OFFENSE END DATE
06/02/2023
INCIDENT START DATE
06/02/2023
INCIDENT END DATE
JUVENILE REFERRAL
FSS
CHARGE TYPE
FELONY
CHARGE SEVERITY ORDINANCE #
810.02(4A)
STATE STATUTE
BURGL
STATUTE CATEGORY
UNOCCUPIED STRUCTURE UNARMED
STATUTE DESCRIPTION
1
COUNTS INCREASED PENALTY
NO
VIOLENCE INDICATOR
N/A
DRUG ACTIVITY DRUG TYPE DRUG AMOUNT BAIL BOND TYPE BOND DATE BOND AMOUNT WARRANT #CHARGE INFORMATIONVICTIM PERSON2
PERSON #COARRESTEE STATUS
NO
JUVENILE?PARENTS CONTACTED?RELATIONSHIP TO SUBJECT
NO
NTA ?
BUSINESS/GOVERNMENT NAME VICTIM TO SUBJECT RELATIONSHIP
NOEL
FIRST NAME MIDDLE NAME
SMITH
LAST NAME SUFFIX DATE OF BIRTH AGE
M
GENDER HEIGHT
W
RACE ETHNICITY ALIAS / MAIDEN ALT NAME DESC.COMPLEXTION
AVERAGE
BUILD WEIGHT EYE COLOR HAIR COLOR PHYSICAL FEATURE
SCARS/MARKS/TATOOS (LOCATION / DESCRIBE)
DUI INDICATOR SPEAKS ENGLISH?THREAT?PROBATION?GANG AFF?SEX OFFENDER?MENTAL HEALTH HOMELESS?
DRIVER LICENSE #DL STATE DL CLASS PLACE OF BIRTH COUNTRY OF CITIZENSHIP
SOC. SEC. #INS #FBI #FCIC/NCIC #BOOKING #SPN #DOC #OTHER ID #
3737
STREET #
N OCEAN
STREET NAME
BOULEVARD
STREET CATEGORY CODE APT/UNIT #
GULF STREAM
CITY
FL
STATE
33483
ZIP CODE ADDRESS SOURCE
RESIDENT
PERSON RESIDENCE CODE
(207) 985-7074
PHONE #E-MAIL
PERMANENT ADDRESS
IDENTIFICATION
NO
VICTIM INFO? Did the victim or the
victim’s family, request that their
personal information remain
confidential pursuant to Article 1
section 16 of the Florida Constitution?
YES
MARSY'S LAW? Was the victim notified of the
right to be informed, to be present, and to be
heard when relevant, at all crucial stages of
criminal proceedings, to the extent that
these rights do not interfere with the
constitutional rights of the accused?
NO
VICTIM ARREST
NOTIFICATION?
Does the victim
wish to be notified
if an arrest has
been made?
NO
VICTIM RELEASE
NOTIFICATION?
Does the victim
wish to be notified
if the defendent is
released?
STRANGER
VICTIM TO SUBJECT RELATIONSHIPMARSY'S LAW230987AGENCY CASE #: 06/02/2023
REPORT DATE:REPORT DATE:
PAGE OF
42PAGE OF
42
TODD
FIRST NAME
SUTTON
LAST NAME
750
BADGE #
OFFICER
RANK
DIGITAL
SIGNATURE METHOD
OFFICER SIGNATURE
09:1406/02/2023ENFORCEMENT OFFICIALI SWEAR/AFFIRM THE ABOVE ATTACHED STATEMENTS ARE TRUE AND CORRECT ON
at
AFFIRMING OFFICIAL NAME BADGE #AFFIRMING AGENCY ORI #SIGNATURE METHOD AFFIRMING OFFICIAL SIGNATURE
WHO IS PERSONALLY KNOWN TO ME OR HAS PRODUCED ______________________________________________ AS IDENTIFICATION. ___LEO/CO (FSS 117.10)
SUBSCRIBED AND AFFIRMED TO BEFORE ME ON
AFFIRMING OFFICIALAT BY ____________________________________________________________
230987AGENCY CASE #: 06/02/2023
REPORT DATE:
PAGE OF
43
ON 6/02/23 AT 0817 HOURS CHIEF JONES, CAPT HASELEY, AND I RESPONDED TO 3737 N OCEAN BLVD IN REFERENCE TO A
REPORT OF A SUSPICIOUS INCIDENT. UPON ARRIVAL CONTACT WAS MADE WITH PROPERTY REPRESENTATIVE MARC
ALLOCCO WHO ADVISED THERE WAS AN UNKNOWN SUBJECT INSIDE THE CABANA HOUSE TO THE REAR OF THE PROPERTY.
UPON GAINING ACCESS, DARIN ELLSWORTH WAS FOUND SLEEPING ON THE FLOOR UNDER STACKED PATIO FURNITURE. HE
ADVISED HE ENTERED THE HOME TO GET OUT OF THE RAIN. MR ELLSWORTH ENTERED THE HOME BY BREAKING AN EAST
SIDE WINDOW AND UNLOCKING IT, THEN CLIMBING THROUGH. PHOTOS TAKEN. NO OTHER DAMAGE TO THE EXTERIOR OR
INTERIOR OF THE HOME WAS REPORTED BY THE COMPLAINANT. MR ELLSWORTH WAS NOT GIVEN PERMISSION BY ANYONE
TO ENTER THE PROPERTY. MR ELLSWORTH WAS THEN TRANSPORTED TO THE GULF STREAM POLICE DEPT. AND THEN TO THE
PALM BEACH COUNTY JAIL.A BODY CAM WAS UTILIZED DURING POLICE RESPONSE TO THIS INCIDENT AND DURING
INTERVIEWS. NO FURTHER.
06/02/2023 08:30
The undersigned certifies and swears that he/she has just and reasonable grounds to believe that the above named defendant committed the following violation of law:
On , at (Specifically include facts constituting cause for arrest.) PROBABLE CAUSE STATEMENTON 6/02/23 AT 0817 HOURS CHIEF JONES, CAPT HASELEY, AND I RESPONDED TO 3737 N OCEAN BLVD IN REFERENCE TO A
REPORT OF A SUSPICIOUS INCIDENT. UPON ARRIVAL CONTACT WAS MADE WITH PROPERTY REPRESENTATIVE MARC
ALLOCCO WHO ADVISED THERE WAS AN UNKNOWN SUBJECT INSIDE THE CABANA HOUSE TO THE REAR OF THE PROPERTY.
UPON GAINING ACCESS, DARIN ELLSWORTH WAS FOUND SLEEPING ON THE FLOOR UNDER STACKED PATIO FURNITURE. HE
ADVISED HE ENTERED THE HOME TO GET OUT OF THE RAIN. MR ELLSWORTH ENTERED THE HOME BY BREAKING AN EAST
SIDE WINDOW AND UNLOCKING IT, THEN CLIMBING THROUGH. PHOTOS TAKEN. NO OTHER DAMAGE TO THE EXTERIOR OR
INTERIOR OF THE HOME WAS REPORTED BY THE COMPLAINANT. MR ELLSWORTH WAS NOT GIVEN PERMISSION BY ANYONE
TO ENTER THE PROPERTY. MR ELLSWORTH WAS THEN TRANSPORTED TO THE GULF STREAM POLICE DEPT. AND THEN TO THE
PALM BEACH COUNTY JAIL.A BODY CAM WAS UTILIZED DURING POLICE RESPONSE TO THIS INCIDENT AND DURING
INTERVIEWS. NO FURTHER.
06/02/2023 08:30
The undersigned certifies and swears that he/she has just and reasonable grounds to believe that the above named defendant committed the following violation of law:
On , at (Specifically include facts constituting cause for arrest.) PROBABLE CAUSE STATEMENTOFFICER'S SIGNATURE
DEFENDANT/JUVENILE SIGNATURE PARENT/GUARDIAN SIGNATURE
I swear/affirm the above attached statements are true and correct.
AFFIRMING OFFICIAL NAME _____________________________________________________SUBSCRIBED AND AFFIRMED TO BEFORE ME ON_____________
AFFIRMING OFFICIAL SIGNATURE___________________________________________ WHO IS A LAW ENFORCEMENT OFFICER OR NOTARY
DateJudge's Signature
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. SIGNING THIS NOTICE TO APPEAR IS NOT AN ADMISSION
OF GUILT. YOUR SIGNATURE ACKNOWLEDGES RECEIPT OF THE INFORMATION LISTED HEREON.
P.C. Exists for Charge(s):YES
NO
230987AGENCY CASE #: 06/02/2023
REPORT DATE:
PAGE OF
44
230987
AGENCY CASE NUMBER
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DESCRIPTION
NAME
DESCRIPTION
NAME
DESCRIPTION
Date
(47ejci/) 3
VALUE
GULF STREAM POLICE DEPT.
246 Sea Road
Gulf Stream, Florida 33483
PROPERTY RECEIPT
V❑ OLEN
RECOVERED
❑ FOUND PROPERTY
❑ EVIDENCE
❑ PROPERTY OF DECEASED
❑ EVIDENCE SENT TO LAB
Case No.
aZ-D1 7
Address where property impounded (Give exact location where •roperty was located)
Time
Owner's Name
ITEM #
DESCRIPTION
I hereby acknowledge that the above list represents all
property taken from my posession and that I have
received a co is receipt.
Signature
Officer
S-1C)-14/4C)fr)
I.D.
Phone No.
I hereby acknowledge that the a ve list represents all property impounded by me in the
official performance of duty as ; 'olice Officer.
Signature
ID
R CEIVED BY
- -
REASON
DATE & TIME
/J
...,....
7F. j
Tvrn hi
E vicOCik- r__
(0/-21 26 2.3 /I e►e A
Final Disposition
Authority
Date & Time
WHITE - EVIDENCE
YELLOW - REPORT
PINK - RECEIPT
PROPERTY RECEIPT
GULF STREAM POLICE DEPARTMENT
AGENCY NAME
246 SEA ROAD
AGENCY ADDRESS
GULF STREAM
AGENCY CITY
PALM BEACH
AGENCY COUNTY
FL
AGENCY STATE
33483
AGENCY ZIP CODE
(561) 278-8611
AGENCY PHONE OTHER AGENCY DETAILS
AGENCY INFORMATION
PROPERTY UNIT USE ONLY Article-Brand-Model No.-Serial No.-Size-Color-Caliber-Barrel
DESCRIPTION:AMOUNTITEM
#PROPERTY TYPE
1 10.00 Prisoner Property WINCHESTER POCKET KNIFE
PROPERTY TAKEN FROM MY POSSESSION
PROPERTY RECEIVED OR RETURNED TO MY POSSESSION OFFICER TODD SUTTON 750
IVAN ELLSWORTHDARIN
1
Page
1of
SIGNATURE:
BADGE #RANK & NAME
I HEREBY ACKNOWLEDGE THAT THE ABOVE LIST REPRESENTS ALL PROPERTY
IMPOUNDED BY ME IN THE OFFICIAL PERFORMANCE OF MY DUTIES:
SIGNATURE:
PRINTED NAME:
I HEREBY ACKNOWLEDGE THAT THE ABOVE LIST REPRESENTS:
1PERSON #
PERSON TYPE
DARIN
FIRST NAME
IVAN
MIDDLE NAME
ELLSWORTH
LAST NAME SUFFIX
09/23/1967
DOB PHONE NUMBER
OVERSEAS
CURRENT ADDRESS (Number and Street)
KEY LARGO
CITY
FL
STATE
33037
ZIP CODE
E426169673430
DRIVER LICENSE NUMBER
FL
DL STATE
PERSON #
PERSON TYPE FIRST NAME MIDDLE NAME LAST NAME SUFFIX DOB PHONE NUMBER
CURRENT ADDRESS (Number and Street)CITY STATE ZIP CODE DRIVER LICENSE NUMBER DL STATE
230987
CASE NUMBER:
1
PROPERTY NO.
06/02/2023
DATE
10:39 AM
TIME
BURGLARY
CASE DESCRIPTION
NOYES
ARREST?
STREET ADDRESS ON STREET, ROAD, HIGHWAY AT LATITUDE AND LONGITUDE
AT FEET OR MILES Direction AT/FROM INTERSECTION WITH STREET LOCATION DESCRIPTION/NAME
CASE INFORMATION
LOCATION
2154457 SA pbsoprintshop.com
561.586.2490 2201962 SA
RECEIPT FOR PRISONER'S PERSONAL PROPERTY
PALM BEACH COUNTY
J �
Q Jacket # . } L! U
Cell #
Pouch #
ARRESTING AGENCY
Arrest Agency ( �O Arrest Date f /' �� j Arrest Time V Cc ST Tamper -Proof Bag.1F- _ `
// , ha r "r2
Print Prisoner's -
_
LAST NAME FIRST NAME MI
Prisoner's 7 $ ( MALE FEMALE WHITES BLACK HISPANIC OTHER
_ -,_s3
DATE OF BI TH SOCIAL SECURITY NUMBER ® ❑ 0 ❑ ❑ ❑
5
5'
10'
20's 50'e
100's Other
U.S. Bills.Total
U.S. Total
Check/M.O. Total
$ 9'
fCoin
$7
$ 7
Total Amount of Money in Writing
r-.-1_
Total Amount of Money Numerical
$
DESCRIPTION OF PERSONAL PROPERTY
BAG 1 OF - BULK PROPERTY - BAG 2 OF
ii -
2. /
2 '
r? _
3.
3.
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4
4
4
4. --- r
5. • '' -`.
5. , ,7_,
5.
6. _ �-
6.
6. -
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7.
7.
7. —
8.
PRISONER IS WEARING
9.
1• /c
10.
-
2. �+
11.
3.
By my signature, I acknowledge that the above -described property is all the property, other than that held as
evidence, in my possession at the time of my arrest.
SIGNATURE OF PRISONER PRINT NAME OF OFFICIAL TAKING PROPERTY ID A SIGNATURE
TRANSPORT
CHAIN OF CUSTODY
I certify the above inventory is correct and I have received all items listed above.
Name ID Number gency Date
2.
.
RELEASE INTAKE
Shower/Uniform Issuance. D/S Print Name and ID #:
Items retained byjnmate Additional property/clothing placed into Property
By my signature, I acknowledge receipt of all my listed property and money in the amount of:
Check Total $ Cash Total $
SIGNATURE OF PRISONER SIGNATURE /ID # OF WITNESS DATE
CANARY - PBSO PROPERTY
PBSO #0637 REV. 01/06
GREEN - TRANSPORTING OFFICER
PINK - ARRESTING OFFICER/AGENCY
WHITE - INMATE