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PALM BEACH
() Sworn Witness Statement
A Affidavit of Prosecution
Case Number: 2-0 002 /
Victim (Vf Witness ( )
Name: froge \ Dung Driver License)
Date of Birth: __12{13(1449 SSN:
Address: 28008 00¢00 {vd . Palm Beath Home Phone: Al%- &68-324F
City/State: ZIP: Cell Phone:
Height: Weight: Hair: Eye:
Employer/Address:
Email:
Ido ( )donot( )desire to prosecute and take what steps are necessary for police action.
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SORI PALM BEACH
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JESSE () Sworn Witness Statement
S POLICE () Affidavit of Prosecution
gu roms Case Number: 31H —
Victim (x) ~~ Witness ( )
Date of Birth: _(6 03] \949 ss: [EE
Address: _332\ Roe) Royle Da 6. @0G Home Phone: _AZA - SAS - 46S
City/State: _Foe) Jondedole ZIP: _33B0% Cell Phone:
Height: _ S'8 Weight: __\60) Hair: _@Rown Eye: Brown
Employer/Address: 2200 S Qcenty Bud
Email:
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Ido () do not () desire to prosecute and take what steps are necessary for police action.
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Signature: _TO\iQ\ Mog ado Date: __2[16]24
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Created 2/5/2016 | Updated 6/142021
X FSS Description
Law Enforcement Investigative Exemptions
܆ 119.071(2)(c) Active criminal intelligence/active criminal investigative information.
܆ 112.533(2)(a) Open Internal Affairs investigation.
܆ 119.071(2)(d) Surveillance techniques, procedures, and personnel; inventory of law enforcement resources, policies, or plans pertaining to mobilization,
deployment, or tactical operations.
܆ 119.071(3)(a), 281.301
AGO-2015-06 Security and fire Safety, Security and Fire Safety Systems, Surveillance video recordings
܆ 119.071(2)(b) Criminal intelligence/investigative information from a non-Florida criminal justice agency.
܆ 943.053, 943.0525 NCIC/FCIC/FBI and in-state FDLE/DOC.
܆ 119.0712(2) Personal information contained in a motor vehicle record.
܆ 316.066(2)(a) Crash reports are confidential for a period of sixty (60) days after filing.
܆ 119.071(5)(g) Biometric identification (fingerprints, palm prints, and/or footprints).
܆ 119.071(4)(c) Undercover personnel.
܆ 119.071(2)(f) Confidential informants (CIs).
܆ 119.071(2)(e) Confession.
܆ 760.40(2)(a) DNA analysis results.
Public Information Exemptions
܆ 365.171(12)(a) Identity of 911 caller or person requesting emergency services.
܆ 119.071(2)(h) Identity of victim of sexual battery, lewd and lascivious offense upon a person less than 16 years old, child abuse, or other sexual offense.
܆ 787.06(9), 119.071(2)(h)(1) Human trafficking victims.
܆ 985.04(1) Juvenile offender records.
܆ 119.071(5)(a)(5) Social Security numbers held by agency.
܆ 119.071(5)(b) Bank account, debit, and/or credit card numbers; credit report(s) held by an agency.
܆ 119.071(2)(i)(j) Assets of a crime victim.
܆ 406.135 Autopsy photographs and video/audio recordings of an autopsy held by the medical examiner.
܆ 395.3025(7)(a),
456.057(7)(a) Medical information.
܆ 394.4615(7) Mental health information.
Employee Information Exemptions
܆ 119.071(4)(d)(2)(a) Home address, telephone, date of birth, or photos of active/former LE personnel, spouses, and children.
܆ 1002.221 Education records/transcripts.
܆ 382.025 Birth certificate.
܆ 119.071(1)(a) Interview/polygraph examination questions and answers.
܆ 394.4615(7) Psychological testing/mental health information.
܆ 119.071(4)(b), 112.08(7) Physical fitness exams/medical information regarding employees.
܆ 112.0455(11), 440.102(8) Confidential Under Drug Free Workplace Act, confidential under drug testing program.
Other
܆ Invoked Marsy’s Law - FL
Constitution, Article1, §16(b) Victim’s rights to prevent the disclosure of certain information or records that could be used to locate or harass the victim or their family.
:Other ܆
Tracking Number: Date:
Case Number/Reference: Specialist Name/ID:
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24-000291
04/29/2025
Gabby Hotac/0283