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State of Ca lifornia Depar1ment of Justice <br />DEATH IN CUSTODY REPORTING FORM <br />BCIA 713 (rev. 11/05) <br />DOJ USE ONLY <br />RECORD KEY <br />AGENCY TYPE <br />□ Police <br />□ Sheriff <br />□ Probation <br />□ State <br />□ Other Local <br />AGENCY NCIC NUMBER <br />Ii'.! ORIGINAL 0 AMENDMENT <br />DATE OF DEATH <br />1 / 20 / 2020 <br />MM DD <br />CII NUMBER <br /> <br />yyyy <br />GENDER <br />b2J Ma le <br />SUBJECT NAME <br />MercadoSegura, Miguel A. <br />Last First <br />DATE OF BIRTH <br />11 / 9 / 1988 <br />MM DD YYYY <br />RACE/ETHNICITY (Check One) <br />□ Other As ian □ Korean <br />Mi ddle <br />COUNTY □ Fe male □ Black □ Laotian <br />□ Chinese □ Other <br />□ Cambodian □ Paci fic Islander <br />DOJ USE ON LY <br />□ Fil ipi no □ Samoan <br />□ Guamanian □ Hawaiian <br />CUSTODY OFFENSE 1:21 Hi span ic □ Vietnamese <br />□ American Ind ian □ White <br />288 PC/148 PC / 69 PC □ Japanese □ As ian Indian <br />CUSTODY STATUS <br />(Check One) <br />li1I Process of Arrest <br />□ In Transit <br />□ Awaiting Booking <br />□ Booked -No Cha rges Filed <br />□ Booked -Awaiting Tria l <br />□ Sentenced <br />□ Out to Court <br />□ Other <br />FACILITY OF DEATH <br />(Check One) <br />~ Crim e/Arre st Scene <br />□ Local Hosp it al <br />0 City Jai l <br />□ County Jail <br />0 Ad ult Camp or Ranch <br />□ Local Juvenile Facil ity/Camp <br />□ Adult Operations and Adult <br />Programs (formerly CDC) <br />□ Division of Juven ile Justice <br />(formerly CYA) <br />□ State Hospital <br />□ Other <br />CUSTODIAL RESPONSIBILITY <br />AT TIME OF DEATH <br />(Check On e) <br />~ Process of Arrest <br />□ City Jail <br />□ Count y Jail <br />□ Adult Camp or Ra nch <br />□ Local Juven ile Faci lity/Camp <br />□ Adult Operations and Adult Programs (formerly CDC) <br />□ Divis ion of Juvenile Justice (fo rmerly CYA) <br />□ State Hos pi tal <br />□ Other <br />MANNER OF DEATH <br />(Check One) <br />121 Pending Investigation <br />□ Natural <br />□ Accidental --Injury to Self <br />□ Acci dental --Injury by Other <br />□ Suicide <br />□ Homicide Wil lful (Law Enforcement Staff) <br />□ Homicide Willfu l (Other Inmate) <br />□ Homic ide Justified (Law En fo rcement Sta ff) <br />□ Homicide Justified (Other Inmate) <br />□ Execution <br />□ Cannot Be Determ ined <br />□ Other <br />LOCATION WHERE CAUSE <br />OF DEATH OCCURRED <br />(Check One) <br />□ Not Applicable (Natural) <br />~ C ri me/Arrest Scene <br />□ Fac il ity --Admin istrative <br />□ Facility --Booking <br />□ Fac ili ty --Living <br />□ Facility --Common <br />□ Facility --Hol ding <br />□ Fac ility --Medica l T reatment <br />□ Othe r <br />MEANS OF DEATH <br />(Che ck On e) <br />b2J Pending Investigat ion <br />□ Not App licable (Natural) <br />□ Handgu n <br />□ Rifle/Sho tgun <br />□ Club , Blunt Instrument <br />□ Ha nd s, Feet, Fists <br />□ Knife , Cutting Instrum ent <br />□ Hanging , Strangulation <br />□ Alcohol/Drug Overdose <br />□ Execu ti on : Lethal Gas/Inj ectio n <br />□ Cannot Be Determined <br />□ Other <br />DAT A SUPPLfED B Y (Please print th e following i11Jor111atio11): <br />Na me: Corporal Esquivel #3295 Title: Inspector -~--------------- <br />Agency: Santa Ana Poli ce Department Telephone : (714) 245-8016 <br />Address: 60 Civic Center Plaza Santa Ana, CA. 92702 <br />Send co mpleted form t o: Department of J u stice <br />C riminal J u stic e Statistics Cent er <br />P.O. Box 903427 <br />Sacramento, CA 94203 -42 70 <br />Fac simile: (916) 22 7-0427 or 227-3561 <br />Telephon e: (916) 227-3545