Form 1-704 Supplementary Homicide Report (SHR)

SUPPLEMENTARY HOMICIDE REPORT

1-704 (Rev. 5-22-07)

OMB No. 1110-0002

This report is authorized by law Title 28, Section 534, U.S. Code. Your cooperation in using this form to list data pertaining to all homicides reported on your

Expires 9-30-10

Return A will assist the FBI in compiling comprehensive, accurate data regarding this important classification on a timely basis. Any questions regarding this report may be

addressed to the FBI, Criminal Justice Information Services Division, Attention: Uniform Crime Reports/Module E-3, 1000 Custer Hollow Road, Clarksburg, West Virginia 26306;

telephone 304-625-4830, facsimile 304-625-3566. Under the Paperwork Reduction Act, you are not required to complete this form unless it contains a valid OMB control number.

The form takes approximately 9 minutes to complete.

1a.

Murder and Nonnegligent Manslaughter

List below for each category specific information for each murder and nonnegligent homicide and/or justifiable homicide shown in item 1a of the monthly Return A. In

addition, for justifiable homicide list all justifiable killings of felons by a citizen or by a peace officer in the line of duty. A brief explanation in the circumstances column regarding

unfounded homicide offenses will aid the national Uniform Crime Reporting Program in editing the reports.

Incident

Situation*

Victim**

Offender**

Data Code

Weapon Used (Handgun, Rifle, Shotgun, Club, Poison, etc.)

Relationship of Victim to Offender (Husband, Wife, Son, Father, Acquaintance, Neighbor, Stranger, etc.)

Circumstances (Victim shot by robber, robbery victim shot robber, killed by patron during barroom brawl, etc.)

Age

Sex

Race

Ethnicity

Age

Sex

Race

Ethnicity

Do Not Write In These Spaces

*

** - See reverse side for explanation

DO NOT WRITE HERE

Recorded

Edited

Month and Year

Agency Identifier

Prepared By

Title

Entered

Verified

Adjusted

Agency

State

Sheriff, Chief, Superintendent, Commanding Officer

FBI/DOJ

SUPPLEMENTARY HOMICIDE REPORT (Continued)

1b.

Manslaughter by Negligence

Do not list traffic fatalities, accidental deaths, or death due to the negligence of the victim. List below all other negligent manslaughters, regardless of prosecutive action taken.

Incident

Situation*

Victim**

Offender**

Data Code

Weapon Used (Handgun, Rifle, Shotgun, Knife, etc.)

Relationship of Victim to Offender (Husband, Wife, Son, Father, Acquaintance, Neighbor, Stranger, etc.)

Circumstances (Victim shot in hunting accident, gun- cleaning, children playing with gun, etc.)

Age

Sex

Race

Ethnicity

Age

Sex

Race

Ethnicity

Do Not Write In These Spaces

* - Situations

A - Single Victim/Single Offender

D -

Multiple Victims/Single Offender

B - Single Victim/Unknown Offender or Offenders

E -

Multiple Victims/Multiple Offenders

C - Single Victim/Multiple Offenders

F -

Multiple Victims/Unknown Offender or Offenders

Use only one victim/offender situation code per set of information. The utilization of a new code will signify the beginning of a new murder situation.

** - Age

-

01 to 99. If 100 or older use 99. New born up to one week old use NB. If over one week, but less than one year old use BB. Use two characters only in age column.

Sex

-

M for Male and F for Female. Use one character only.

Race

-

White - W, Black - B, American Indian or Alaskan Native - I, Asian or Pacific Islander - A, Unknown - U. Use only these as race designations.

Ethnicity -

Hispanic Origin - H, Not of Hispanic Origin - N, Unknown - U.