Free Supplementary Homicide Reporting Form (for Massachusetts Police Departments) - Massachusetts

Supplementary Homicide Report - Massachusetts Form
1a. Murder and Non-Negligent Manslaughter
Auto Weap-check

Victim **
Situation**

Offender**

Data Code

Weapon Used (see codes on reverse side)
Location**

Relationship of Victim to Offender (see codes on reverse side)

Circumstance of Offense (see codes on reverse side)

Ethnicity

Agency Case #

1b. Manslaughter by Negligence

Ethnicity

Do not write in these spaces

Race

Race

Age

Age

Sex

Sex

DO NOT WRITE HERE

Recorded Edited

Month and Year

Agency ORI MASSACHUSETTS

Perpared by

Title

Punched Verified

Agency
**

State

Chief, Sheriff, Commissioner, Superintendent

Adjusted

See Codes on Reverse

Weapon Used

Relationship of Victim to Offender

Curcumstance of Offense

Code
11 12 13 14 15 20 30 40 50

Description
Firearms Handgun Rifle Shotgun Other gun Knife Blunt object Personal weapons Poison

Code
55 60 65 70 75 80 85 99

Description
Pushed out window Explosives Fire Drugs Drowning Strangulation Asphyxiation Unknown

Code
1 2 3 4 5 6 7 8 9 10 11 12

Description
Husband Wife Common-law Husb Common-law Wife Mother Father Son Daughter Brother Sister In-law Stepfather Stepmother Stepson Stepdaughter

Code
16 21 22 23 24 25 26 27 28 29 30 31 40 99

Description
Other family Neighbor Acquaintance Boyfriend Girlfriend Ex-husband Ex-wife Employee Employer Friend Homosexual rel. Other known Stranger Unknown

Code
2 3 5 6 7 9 10 17 18 19 26 32 40 41 42 43

Description
Rape Robbery Burglary Larceny Motor veh theft Arson Prostitution Other sex offense Narcotics law Gambling Other felony Abortion Lover's triangle Killed by babysitter Brawl under alcoh. Brawl under drugs Arg. over money

Code
45 46 47 48 49 50 51 52 53 59 60 70 80 81 91 92 99

Description
Other arguments Gangland killing Youth gang killing Institutional killing Sniper attack Hunting accident Gun cleaning Child playing w/gun Other negl. gun Other negl mansl. Other Suspected felony Felon by citizen Felon by police Domestic/family Child abuse Unknown

Situation and Other Codes
A Single victim/ single offender Single vict/ Mult offenders Mult victims/ mult offenders B SingleVictim / unknown offender Mult victims/ single offender Mult victims/ unk. offenders

C

D

13 14

E

F

15

Age

01 to 99. If 100 or older, use 99. New born up to 1 week, NB; over 1 week but less than one year, use BB 1 Air/bus/train term. Bank/Saving & Loan Bar/Night Club Church/Synagogue Commercial/Office Bld Construction Site 7 8 9 10 11 12

44

Location of Offense
Convenience Store Department Store Drug Store/Doc's Off Field/Woods Govt/Public Building Grocery/supermarket 13 14 15 16 17 18 Hiway/Road/Alley Hotel/Motel/etc Jail/Prison Lake/waterway Liquor store Parking lot/garage 19 20 21 22 23 24 25 Rental Storage Facility Residence/home Restaurant School/college Service/gas station Speciality store Other/unknown 2 3 4 5

Sex Race:

M for Male, F for Female, U for Unknown W - White; B - Black; I - American Indian or Alaskan Native; A - Asian or Pasicfic Islander; U - Unknown

Ethnic: Auto Weap: Form CRU-1, rev 11/94

H - Hispanic; N-Not Hispanic; U-Unknown

6

T if AUTOMATIC weapon used

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