ACTICAL RESPONSE REPORT/chicago Police Department1. DATE OF INCIpENT TIME 2. ADDRESS OF OCCURRENCE 3.LOCATION CODE

31-MAY-2011 22:44:00 12355 S WAI.LACE ST CHICAGO, IL 60628 303 0523(a 6. POSITION 6, UST NAME 7, FIRST NAME 8. STAR NO. 9. SF~( 10. RACE CODE 11. AGE 72. HT. 13. WT.

9161 CHAVEZ MACARIO 9084 ~o,M []ozF S . - 510 184Q 14. DATE OF APPT. 16.EMPLOYEE N0. 18. UNIT 6 BEAT OF ASSIGNMENT 17. DUN STATUS 18. MEAlBER INJURED? 19, MEMBER IN UNIFORM?

z 25SEP-2006 153 05648 ~ o~ on ~ 02 ar ~ o~ v~ ~ oz No ~ot vee [] 02 rm20. AST NAME 27. FIRST NAME . M.1. .SEX 24.RACE 25. P.0.8. 28. HI'. 27. Wi.

~~ CROSS CALVIN ~o,M ~~o2F B~KzO 28. ADDRESS CHICAGO, IL ~•TE~EAFIONE NO. 30. WAS SUBJECT ARMEOTDTNER (SPECIFY, 31.SUBJECT INJURED? 32. SUBJECT ALLEGED INJURY9

QflNEARM -REVOLVER

~ 01 YBe O 02 No ~ 01 Yee ~ 02 No ~ Ot Yes ~ 02 No

33. WHERE WA6 MEOICAI TREATMENT OBTAINED? 31, BY WHOM1 35.CONDITION ~ p~ Agxre~tly Normal ~ 02 Unuer In~uancaO~

PRONOCINCED ON SCENE BY ME ~p3 Hoappgfirpy ~] oy rw~Ho~ie~ea ~ 05 Refused McAlcel PJdz

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38. CHARGES PUCED ~ q,~ ~7.C8 NO. IR ~'1~. ❑ ~A

38. 7AH91VE RfiS19TER AC1riE R8919TER A38AILAN7:A99AULT A9SAILANf;BA7TEgy gHSAIUNT:DEAOLY FORCE

,J~Np N y

DID N07 FOLLOWVERBAL DIRECTION ~ FLED ~ IMMI(~NT THREAT ~ ATTACK Wf7H WEAPON ~-

USES FORCE LNfEIY TOCAUSE DEATH OR

V z OF BATTERY caEr.T eo~nr wut~+~ 0m U.

STIFFENED(DEAD WfIGF1f) ~ PULLED AWAY ~ OTHER

ATTACK WITHOUT~~~ ~ YVFliPON

~ Q OTHER OTHER F4ED WITS NDGUN OTHER ~_ OTHER POINTED HANDGUN A7 OFFlCERB

ŷy MEMBER PRESENCE ~ OPEN HAND STRNCE ~ E180W STRII~ ~ KNEE STRIKE ~ FIREARM4a

VERBAL COMMANDS ~ TAKE DOVJNIEMERGENCYy W

Z

w,riocurf~ac

OC CHEMICAL. YJEAPgJ

CLOSED HANDSIRIKFIPUNCH ~ KICKS ~ OTHER

M

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~

~

WRIS OCKL~GWINE ~ IMPACT WEAPONd

~ NARMBAR I~1

(~6G~ ~~ ~0%~) I_I FACT MUNITION

jyPRES4~RE SENSITIVE AREAS

TASER Probe gsc}y~geJ❑ (Peacribe in Box 40) ❑Y

V

~ ~ ~

CONTROL INSiRUMENi~

TASER (Conled &un)

LV OCICHEMIG4L WEAPON

7ASER (Les9r Terpele0) ~ ~ '

WIAU7HORIZATION TASER (SpaAc DI5{NayetlJ ~ orr~a -OTHER OTHER

38, ' ~~CHEMiCAL WEAPON AUTHORIZED BY (NAME) 40. ADpIT10NAL INFORMATION

~_~ OFFENDER'S HANDGUN RECOVERED.7NA

POSITION 9TAF2 NO. UNIT

I--2W 41. WEAPON TYPE ~j O4 BEM~.gUTO PISTOL 42. INCIDENT OCCURRFA 43. 41GHiING CONDITIONS [] O1 Deyggh! 44.WEATHER CONDITIONSO

Z L~ 01 REVOLVER ~ Ob CHEMICAL NIEAPON ~ 1~~~ ~ p~p~y ❑ ~Nlght ❑ 03 Dewn [] 04 Dusk CLEAR

❑ OSPoor ArtlNciel Q~ 08 Gopd AAlfidel..

L. J 02 RIFl.E L J OB TgSER (Probe Discharge)4b. MAKEiMANUFACiURER 46. MODEL 47.6ARREL LENGTH 48. CPLIBERlGAUCE

~W

L~03 SHOTGUN ~~07:Oh1ER FA.WDUe7PoE9~FORMERtI~-U&-(BEREITA92 5 9MMQ U8A COHP,BRONCO)

=U 49. TASER

DAR71D NO, 50. WEAPON SER41L No. (IncluOe LeMere) 51. CHICAGO GUN RECa. NO. 52, Il FIREARM OWNER ID. N0. 59. FUWDGUN CER'f~FICATE NO,

y BER277035 R001725S 5748Q402OZ b4, SPECIAL WEAPON CERTIFICATE N0. 54. PROPERTY INVENTOFV NO. 58, lYPE OF AMMUNITION USED 57.N0. OF WEAt'ONS DISCH4RGED BY 58.TOTAL. NO.OF SHOTS~MEMBER

a UNK Department Issued THIS MEMBER. Z FIRED 3

j 59.WNO FIRED FIRSTSHOT ~030T'F1ER (SPEGFI~ 60.WAS FHiEAFiM RELOADED 61. NO OF CATORIDGE& 62. Fi0W WAS MEM9ER'S HANDGUN WORN [~p90THER (SpeGfy) oy ~ 01 MEMBER [~ 02 OFFENDER

BRING HJCIDENT[] 01 YES ~ 02 NO

SHOT SHEDSRELOADED ~ 01 RT, SIDE (WA19T) [] 02 LT. SIDE (WAIST)

~~

83. WAS MEMBER5 HANDGUN DRAWN ~ECIFY METHOD/EOUIPMENT USED TO RELOAD '~ zHOW ~] p3 OTHER (Specify)

Ot STRONG 61DE DRAW [] 02 CROSS DRAW

. 85. DID MEMBER USE SIGHTS

~ O7 YES ❑

02 NOO

,~

86. DESCRIBE PROTECTIVE COVER USED (LIGHT POLES, DOORWAYS, CAR, FURNITURE, EEC) 67. DISTANCE BETWEEN INVOLVED MEMBER 8 OFFENDER WHEN FIRST SHOT WAS FfRED N

NNONE ❑ 010 -OS F7. ~ 0205-tO FT, u 0310-~S FT. [~ 040VER 15 FT. ~1

88. PERSON/OBJECT STRUCK AS RESULT OF THE DISCHARGE OF MEMBERS WEAPON 68. POSITION OF MEMBER DISCHARGING WEAPON ~ 01 6TANDING ~] 02 LYING DOWN C~1

~Q 07 PERSON ❑ 02 OBJECT ~r;}Q3 BOTH ❑ 04 UNKNOWN [] 03 SITTING ~] 04 KNEELING ~ 05 OTHER (SPECIFY)

72 NOTIFICA710NS (OC OR TASER INCIDENT): ❑ OEMC ~ DESK SGT.& W.C.IDIST. OF OCCUR.j p NOTIFfCATIONS (FIREARM INCIaENT): ~ OEMC f~ DESK SGT.& W.C.IDIST, OF OCCUR. ~ OP COMMAND p~ DET. DIY. z

z Members will ensure that all required notifications and all witnesses to this use of force are documented in the appropiate case report. ~ ~

73. REPORTING MEMBER (Prkq Neme) STARIEMPLOYEE NO. SIGNATURE W

NW CHAVEZ, MACARIO 90$4~ 01JUN-201104:23:48 N

Q Reviewing supervisor will ensure the legibility and completeness of this report and attesf by entering the required Information below. '`~z(~ 74. REVIEWpJG SUPEMISOR (P~fnl Name) STAR NO. SIGNA7l1RE GATE REVIEWED . TME~

~n JONES, JAMES E 73 01~JUN-2011 04:30:04

'0-11.377 {REV. 10107) / Ary ,~ /QL/c+C9O tr/~„~/~ y~

a ~ ~

DNA

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1• WEAPO~J TYPE u 04 SEMI~AUTO PISTOL 42. INCIDENT OCCURRED 43. UGNTING CONDITIONS ~ 01 OayGght 44. WEATHER CONOITION3

D7 REVOLVER ~ OS CFIEMICAL WEAPON , ~ry~g ~ p~yp~

~"~

U 02 Night ~] 03 Dewn ~] 04 Duek CLEAR02 RIFLE ~ O6 TASER

05 Pom Arllfidel p8 Gootl ArtiAcial

45. MAICEMIANUFACTURER.119•(BOOVOUgR~~CMIEF

48, MODEL 47, BARREL LENGTH 48. CALI6ERlGAUGE~.U3 SF10TGUN ~ 070TF1ER gpECUlWE990N MB~P 15 ~6 223!5.56

9. TASER DPRT ID NO. 50. WEAPON SERIAL No, (Include Lettere) 51. CHICAGO GUN REG. NO. 52, IL FIREARM OWNER ID. NO. 53. HANDGUN CERTIFICATE NO.

SW965AS 574$0402i. SPECLIL WEAPON CER7IFICA7E NO. 55. PROPERTY INVENTORY NO, 58. TYPE OF AMMUNITION USED 57.N0. OF WEAPONS OISCHARGEO 8Y 58. TOTAL NO.OF 9H0T3 MEMBER

UNK Department Issued THIS MEMOER. ,1 FIRED 28

59. WHO FIRED FIRST SHOT X03 OTHER (SPECIFY) 80. WAS FIREARM RELOApED 81. NO OF CATURIDGES/ 82. HOW WAS MEMBER'S HPNDGUN WORN ~ 03 07HER (Specf(y)

01 MEMBER []02 OFFENDER DURING INCIDENT SHOT SHELLS BLUNa ON CHEST ' V

Of YES ~ 02 NO RELOApEp ❑ O1 RT. SIDE (WPJSn ❑ 0217. SIpE (WAIST') .~

83. HOW WAS MEMBER'S HANDGUN DRAWN ~ 03 OTHER (Spedfy) • SPECIFY METHOD/EQUIPM6NT USED TO RELOAD 85. DID MEMBER USE SIGHlS ~

01 S7RONG SIDE bRAW ❑ 02 CROSS DRAW 8LUH0 ON CHEST ~ Z

- ~ Ot YFS ~ 02 NO ~~,1, O

66. DESCRIBE PROTECTIVE LAVER USFA (LIGHT POLES, DOORWAYS, CAR, FURNITURE, ETC) 87. DISTANCE BETWEEN INVOLVED MEMBER 8 OFFENDER WHEN FIRST SHOT WAS FIRED N

NONE Q 010.OS FT. ~ 0205-10 FT. ~ 0310.15 FT. ~] O40VER 15 fT.

B8. PERSOWOBJECT STRUCK AS RESULT Of THE DISCHARC£ OF MEMBERS WEAPON 89. POSITION OF MEMBER pISCHARGINC> WEAPON ~ 01 STANDING ❑ 02 LYING DOWN DTI

01 PERSON ❑ 02 OBJECT [J 03 BOTH ❑ 04 UNKNOWN [] 03 SITTING ~ pq KNEELING ❑ 05 OTHER (SPECIFY)

WATCH COMMANDER/OCIC REVIEW

7HE WA7CH COMMANDEq WILL COMPLETE THE REVIEW SECTION FOR 1.) ALL WCIDENTS TFWT DID NOY INVOLVE THE DISCHARGE OF A FIREARM; Z.) FIREARM DISCHARGEINCIDEMS INVOLVING THE DESTRUCTION OF AN ANIMAL OR; 3.) ACCIDENTAL DISCHARGE OF A FIREARM NOT RESULTING IN AN INJURY TO ANY PERSON.

THE ADS WILL COMPLETE THE REVIEW SECTION FOR ALL INCIDENTS INVOLVING; 1.) THE OISCHPRGE OF A FIREARM OR IMPACT MUNITIONS 9Y OR AT A DEPARTMENTMEM9ER E)(CE7T FOR AN ANIMAL DESTRUCTIgJ OF2 AN ACCIpENTAI DISCHARGE THAT DOES NOT RESULT IN AN INJURY TO ANY PERSON; 2.) MEMBER'S USE OF FORGEBV WHATEVER MEANS 7HAT RESULTS IN THE DFAiI-1 OF A PERSON; 3.) ANV LESSER USE OF FORCE 0Y A DEPARTMENT MEMBER WHEN THAT USE OF FORCE STEMS FROMTHE SAME INCIDENT DESCRIBED NERE IN 1 OR 2.

75. SU&IECT'S STATEMENT REGARDING THE USE OF FORCE pNq REFUSED UNABLE TO INTERVIEW (SpeG(y Reeso~)

The subject is deceased.

78, WATCH COMMANpERlOCIC RATIONALE FOR BOX Y7 FINDING

It is the preliminary determination of the undersigned that Police Officer Macario Chavez acted incompliance with Department policy in that the offenderpointed a handgun in the direction of Officer Chavez. In fear of his life and his partners Ilfe Officer Chavez discharged his weapon. CL# 1045804 U# 11-27

77, WATCH COMMANDERIOCIC FINDING BASED UPON CURRENTLY AVAtUBLE INFpRµgTION:

1 HAVE CONCLUDED TENT THE MEMBER'S ACTIONS (~ I HAVE CONCLUDED iHA7 FURTHER INVESTIGA710N IS REOUIREp.WERE tN COMPLIANCE WITH DEPARTMENTPROCEWRES NJD DIRECTIVES,

roc No~cRr+o. 1045804 OBTAINED

>B. WATCH COMMANDER/OdC (PAnt Name) SIGNATURE Q4TE COMPLETED TIME

WELCH III, EDDIE L 01~1UN-2011 04;57:33

79. DISTR18lITION OF OitIGINP17Rq:

A TRR PACKET, INCLUDING THE TRR AND CAPIES OF TF~, BELOW LISTED A7TACHMEN7S WILL 9E FORWARDED TO THE OFFICE OF PROFESSIONAL. STANOPlt0.S.

ATTACHMENTS -PHOTOCOPIES OF: ~ SUPPLEMENTARY REPORT ❑ I.O.D. REPORT BD. TOTAL, TRR's THIS EVENT No.

CASE REPORT ~ OFFICER BATTERY REPOF2T [] CR MlITIATION REVORT 3

ARREST REPORT ~ TO-FROIh3UBJECT REPORTS FROM DEPARTMENT WITNESSES)

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