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2506656900 P .01 /0 1 <br />TRANSACTION REPORT <br />JA N /21/2 020 /T UE 0 9:09 AM <br />FAX(T X ) <br /># DATE STARTT. RECEIVER COM.TIME PAGE TYPE/NOTE FILE <br />001 JAN/21 09:0SAM 919162270427 0 :00:27 1 MEMORY OK SG3 1735 <br />St;t<,ofCal(om~ Department cl Justice <br />DEATH IN CUSTODY REPORTING FORM <br />BCJA 1'13 (~v.11/05) <br />,- <br />DOJ USE ONLY <br />RECORD KEY <br />AGENCY TYPE <br />□ Police <br />0 Sheriff <br />0 Pro bation <br />D State <br />D Other Local <br />AGENCY NCIC NU MBER <br />COU NTY <br />OOJ USE ONL Y <br />12] ORIGINAL O AMENDMENT <br />DATE OF DEATH SUBJECT NAME <br />1 I 20 I 202 0 <br />MM DD YYYY <br />CII NUMBER <br /> <br />GENDER <br />~ Male <br />D Female <br />MercadoSegu ra, Mig ue l A. <br />Last First <br />DATE OF BIRTH <br />11 / 9 / 1988 <br />MM DD yyyy <br />RACE/E THNICITY (Check One) <br />□ other Asian □ Korean <br />0 Black O Laoti an <br />0 Chinese O Other <br />0 Cambodian O Pacific Islande r <br />0 Filipino O Samoan <br />0 Guamanian D H awaiian <br />Midd le <br />CU STOD Y OF FENSE ~ Hispanic O Vietnamese <br />CUSTO DY STATU S <br />(Clteck 011.t) <br />QI Process of Arrest <br />0 In T ransit <br />288 PC/14 <br />0 Await ing Booking <br />0 Booked - No Charges Filed <br />0 Booked -Awaiting Trial <br />□ Sentenced <br />D Out to Cou rt <br />0 Other <br />FACILITY OF DEATH <br />(Check One) <br />r:iJ Crime/Arrest Scene <br />0 Local Hospital <br />0 City J ail <br />□ County Jail <br />□ Adult Camp or Ranch <br />□ Local Juvenile Facility/Camp <br />□ Adult Operatio ns and Adult <br />Programs (formerly CDC) <br />□ Division of Juvenile Justice <br />(forrnerly CYA) <br />0 State Hospital <br />0 Other <br />0 American Indian □ W hite <br />8 PC/ 69 PC □ Japanese □ Asian Indian <br />CUSTODI AL.. R~SPONSIB ILJTY <br />AT TIME OF DEATH <br />(Check01u) <br />QI Process of A r res t <br />0 CityJall <br />□ County Ja il <br />0 Adult Camp or Ranch <br />0 Local Juvenile Faci lity/Camp <br />0 Adult Operations and Adult Programs (formerly CDC) <br />0 Divi sion of Juvenile Justice (formerly CYA) <br />0 State Hosp ital <br />□ Other <br />MANNER OF DEATH <br />(Check One) <br />li2I Pend ing lnvestlga11on <br />0 Natura l <br />0 Accidental --Injury ·to Self <br />0 Accide ntal-~ Injury by Other <br />0 Suicide <br />0 Homicide Willfu l (Law E nforcement Staff) <br />0 Homi cide Willful (Other I nmate) <br />□ Homicide J ustified (Law Enforcement Staff) <br />□ Homicide Justifi ed {Other Inmate) <br />□ Execution <br />□ Cannot Be Determined <br />0 Othar <br />LOCATION WHERE CAUSE <br />OF DEATH OCCURRED <br />(Check One) <br />0 Not Applicable (Natllral} <br />GiJ Crime/Arrest Scene <br />0 Facility --Ad ministrat ive <br />□ Facility --Booking <br />0 Facility --Living <br />D Facility --Common <br />□ Facility -- Holdin g <br />0 Faclllty --Medical Treatment <br />0 Other <br />MEANS OF DEATH <br />(Check One) <br />~ Pend ing Investigation <br />0 Not Applicable (N atural) <br />0 Handgu n <br />0 Rifle/Shotgun <br />0 Club, B lunt Instrument <br />D Hands, Feet, Fists <br />D Kn ife, Cutting Instrument <br />0 Hang ing , Stran gulation <br />□ Alcohol/Drug Overdose <br />0 ~ecutlon : Letha l Gas/Injection <br />□ Cannot Be Determined <br />□ Other <br />DATA SUPPLIED BY (Please print rhefollowing information): <br />Name: Co rpo ral Esq uiv e l #3295 Title:_l_ns_.p_e_c_to_r __________ _ <br />Age ncy : Santa Ana Poli ce Depa1i me nt T eleph one :.,_(7_1_4..,,.,l _2_4_5 _-8_0_1_6 ______ _ <br />Address; 60 Civi c Cente r Pl aza Santa A na, CA. 92702