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COUNTY OF ORANGE <br />(LAST) <br />Age3O Sex Male Race _.:..H::::is~p::::a.:.:.ni:.::::c~ Ht.ufc_ <br />How Identified ------By Date ------- <br />Date of Death 1/21/2020 Time 12:31:00 AM -~::..:.:.:='-"--D EST D FD <br />PLACE OF DEATH ...lJ_ <br />UC Irvine Medical Center tJ p<3,.erl/ ttfrt,t/):fr{7 <br />(Include hospital admission date and time when applicable) 1/21/2020 12:02:00 AM <br />PROBABLE <br />CLASSIFICATION: 0 NATURAL O ACCIDENT ~ HOMICIDE O SUICIDE O TRAFFIC ~ 010 0 INCUSTODV <br />COMMENTS <br />The decedent was shot by on duty P.0lice officers serving a warrant. He was transported to the hospital and pronounced dead in the ER. <br />VUA.A)c; <br />'LAW ENFORCEMENT AGENCY <br />Primary Agency Fountain Valley Police Department Report #..:2:.:0'-'·0:.:2:.:5;..:.1.:.6 ___ _ Det/lnv T. Shook #320 <br />Other Agency Orange County District Attorney Report# ________ Det/lnv <br />INSTRUCTIONS: ACCESS PER PROTOCOL O HOLD POST O POSSIBLE CHARGES PENDING O Do Not Undress <br />0 Do Not Print/pend GSA O GSA completed Kit -----t,1'ake Tox D Embalm after post/per ______ _ <br />Special Instructions: <br />D Contaminated/Conte lous <br />EVIDENCE RECEIVED BY FSC: <br />D Ante-mortem blood sample By: ------From Date Tlmo --------------- <br />□---------By: ------From Date Time --------------- <br />AUTOPSY NOTIFICATIONS: <br />~CSD / ID Unit \ <br />Conference Date ~ ~Q, Time Pathologist <br />. FR# ~o -oq By Date/Time <br />; <br />CSD/Crlmlnallst <br />~ <br />hone t By Date/Time <br />D/SO Det/lnv By Date/Time honeg;, (q-~q / <br />A Investigator Phone By Date/Time <br />0 OCSO/Jall Doctor Phone By Date/Time <br />□other Phone By Date/Time <br />D other Phone By Date/Time A