HomeMy WebLinkAboutDOJ reporting Form _RedactedState of Ca lifornia Depar1ment of Justice
DEATH IN CUSTODY REPORTING FORM
BCIA 713 (rev. 11/05)
DOJ USE ONLY
RECORD KEY
AGENCY TYPE
□ Police
□ Sheriff
□ Probation
□ State
□ Other Local
AGENCY NCIC NUMBER
Ii'.! ORIGINAL 0 AMENDMENT
DATE OF DEATH
1 / 20 / 2020
MM DD
CII NUMBER
yyyy
GENDER
b2J Ma le
SUBJECT NAME
MercadoSegura, Miguel A.
Last First
DATE OF BIRTH
11 / 9 / 1988
MM DD YYYY
RACE/ETHNICITY (Check One)
□ Other As ian □ Korean
Mi ddle
COUNTY □ Fe male □ Black □ Laotian
□ Chinese □ Other
□ Cambodian □ Paci fic Islander
DOJ USE ON LY
□ Fil ipi no □ Samoan
□ Guamanian □ Hawaiian
CUSTODY OFFENSE 1:21 Hi span ic □ Vietnamese
□ American Ind ian □ White
288 PC/148 PC / 69 PC □ Japanese □ As ian Indian
CUSTODY STATUS
(Check One)
li1I Process of Arrest
□ In Transit
□ Awaiting Booking
□ Booked -No Cha rges Filed
□ Booked -Awaiting Tria l
□ Sentenced
□ Out to Court
□ Other
FACILITY OF DEATH
(Check One)
~ Crim e/Arre st Scene
□ Local Hosp it al
0 City Jai l
□ County Jail
0 Ad ult Camp or Ranch
□ Local Juvenile Facil ity/Camp
□ Adult Operations and Adult
Programs (formerly CDC)
□ Division of Juven ile Justice
(formerly CYA)
□ State Hospital
□ Other
CUSTODIAL RESPONSIBILITY
AT TIME OF DEATH
(Check On e)
~ Process of Arrest
□ City Jail
□ Count y Jail
□ Adult Camp or Ra nch
□ Local Juven ile Faci lity/Camp
□ Adult Operations and Adult Programs (formerly CDC)
□ Divis ion of Juvenile Justice (fo rmerly CYA)
□ State Hos pi tal
□ Other
MANNER OF DEATH
(Check One)
121 Pending Investigation
□ Natural
□ Accidental --Injury to Self
□ Acci dental --Injury by Other
□ Suicide
□ Homicide Wil lful (Law Enforcement Staff)
□ Homicide Willfu l (Other Inmate)
□ Homic ide Justified (Law En fo rcement Sta ff)
□ Homicide Justified (Other Inmate)
□ Execution
□ Cannot Be Determ ined
□ Other
LOCATION WHERE CAUSE
OF DEATH OCCURRED
(Check One)
□ Not Applicable (Natural)
~ C ri me/Arrest Scene
□ Fac il ity --Admin istrative
□ Facility --Booking
□ Fac ili ty --Living
□ Facility --Common
□ Facility --Hol ding
□ Fac ility --Medica l T reatment
□ Othe r
MEANS OF DEATH
(Che ck On e)
b2J Pending Investigat ion
□ Not App licable (Natural)
□ Handgu n
□ Rifle/Sho tgun
□ Club , Blunt Instrument
□ Ha nd s, Feet, Fists
□ Knife , Cutting Instrum ent
□ Hanging , Strangulation
□ Alcohol/Drug Overdose
□ Execu ti on : Lethal Gas/Inj ectio n
□ Cannot Be Determined
□ Other
DAT A SUPPLfED B Y (Please print th e following i11Jor111atio11):
Na me: Corporal Esquivel #3295 Title: Inspector -~---------------
Agency: Santa Ana Poli ce Department Telephone : (714) 245-8016
Address: 60 Civic Center Plaza Santa Ana, CA. 92702
Send co mpleted form t o: Department of J u stice
C riminal J u stic e Statistics Cent er
P.O. Box 903427
Sacramento, CA 94203 -42 70
Fac simile: (916) 22 7-0427 or 227-3561
Telephon e: (916) 227-3545
2506656900 P .01 /0 1
TRANSACTION REPORT
JA N /21/2 020 /T UE 0 9:09 AM
FAX(T X )
# DATE STARTT. RECEIVER COM.TIME PAGE TYPE/NOTE FILE
001 JAN/21 09:0SAM 919162270427 0 :00:27 1 MEMORY OK SG3 1735
St;t<,ofCal(om~ Department cl Justice
DEATH IN CUSTODY REPORTING FORM
BCJA 1'13 (~v.11/05)
,-
DOJ USE ONLY
RECORD KEY
AGENCY TYPE
□ Police
0 Sheriff
0 Pro bation
D State
D Other Local
AGENCY NCIC NU MBER
COU NTY
OOJ USE ONL Y
12] ORIGINAL O AMENDMENT
DATE OF DEATH SUBJECT NAME
1 I 20 I 202 0
MM DD YYYY
CII NUMBER
GENDER
~ Male
D Female
MercadoSegu ra, Mig ue l A.
Last First
DATE OF BIRTH
11 / 9 / 1988
MM DD yyyy
RACE/E THNICITY (Check One)
□ other Asian □ Korean
0 Black O Laoti an
0 Chinese O Other
0 Cambodian O Pacific Islande r
0 Filipino O Samoan
0 Guamanian D H awaiian
Midd le
CU STOD Y OF FENSE ~ Hispanic O Vietnamese
CUSTO DY STATU S
(Clteck 011.t)
QI Process of Arrest
0 In T ransit
288 PC/14
0 Await ing Booking
0 Booked - No Charges Filed
0 Booked -Awaiting Trial
□ Sentenced
D Out to Cou rt
0 Other
FACILITY OF DEATH
(Check One)
r:iJ Crime/Arrest Scene
0 Local Hospital
0 City J ail
□ County Jail
□ Adult Camp or Ranch
□ Local Juvenile Facility/Camp
□ Adult Operatio ns and Adult
Programs (formerly CDC)
□ Division of Juvenile Justice
(forrnerly CYA)
0 State Hospital
0 Other
0 American Indian □ W hite
8 PC/ 69 PC □ Japanese □ Asian Indian
CUSTODI AL.. R~SPONSIB ILJTY
AT TIME OF DEATH
(Check01u)
QI Process of A r res t
0 CityJall
□ County Ja il
0 Adult Camp or Ranch
0 Local Juvenile Faci lity/Camp
0 Adult Operations and Adult Programs (formerly CDC)
0 Divi sion of Juvenile Justice (formerly CYA)
0 State Hosp ital
□ Other
MANNER OF DEATH
(Check One)
li2I Pend ing lnvestlga11on
0 Natura l
0 Accidental --Injury ·to Self
0 Accide ntal-~ Injury by Other
0 Suicide
0 Homicide Willfu l (Law E nforcement Staff)
0 Homi cide Willful (Other I nmate)
□ Homicide J ustified (Law Enforcement Staff)
□ Homicide Justifi ed {Other Inmate)
□ Execution
□ Cannot Be Determined
0 Othar
LOCATION WHERE CAUSE
OF DEATH OCCURRED
(Check One)
0 Not Applicable (Natllral}
GiJ Crime/Arrest Scene
0 Facility --Ad ministrat ive
□ Facility --Booking
0 Facility --Living
D Facility --Common
□ Facility -- Holdin g
0 Faclllty --Medical Treatment
0 Other
MEANS OF DEATH
(Check One)
~ Pend ing Investigation
0 Not Applicable (N atural)
0 Handgu n
0 Rifle/Shotgun
0 Club, B lunt Instrument
D Hands, Feet, Fists
D Kn ife, Cutting Instrument
0 Hang ing , Stran gulation
□ Alcohol/Drug Overdose
0 ~ecutlon : Letha l Gas/Injection
□ Cannot Be Determined
□ Other
DATA SUPPLIED BY (Please print rhefollowing information):
Name: Co rpo ral Esq uiv e l #3295 Title:_l_ns_.p_e_c_to_r __________ _
Age ncy : Santa Ana Poli ce Depa1i me nt T eleph one :.,_(7_1_4..,,.,l _2_4_5 _-8_0_1_6 ______ _
Address; 60 Civi c Cente r Pl aza Santa A na, CA. 92702