City of Madison, Wisconsin



| |Case Number: |      |

|Further attention required at this address? | Yes | No |

|Address: |      |

|First Attempt: |DATE: |      |TIME: |      |

|Second Attempt: |DATE: |      |TIME: |      |

|Third Attempt: |DATE: |      |TIME: |      |

|Actual Contact: |DATE: |      |TIME: |      |

|Interviewing officers directed to |      |      |      |

|complete interview by? | | | |

| |INTERVIEWING OFFICER |IBM # |AGENCY |

| |      |      |      |

| |INTERVIEWING OFFICER |IBM # |AGENCY |

|Is the scene visible from this location? | Yes | No |

|Approximate distance and direction from this address to crime scene: |      |

Individual Information

|Name: |      |

| |LAST NAME |FIRST NAME |MIDDLE INITIAL |

|DOB: |      | | |

|Relationship to others |      |

|interviewed/involved: | |

|Work: |      |

|Address: |      |

|Work Phone: |      |Hours: |      |

|Cell Phone: |      | | |

Vehicle Information

|Vehicle: |PLATE: |      |TYPE: |      |

| |STATE: |      |YEAR: |      |

| |MAKE: |      |MODEL: |      |

| |COLOR: |      | | |

|Owner/Primary Driver: |      |

Others at Residence

|Name: |      |

| |LAST NAME |FIRST NAME |MIDDLE INITIAL |

|DOB: |      | | |

|Relationship to others |      |

|interviewed/involved: | |

|Work: |      |

|Address: |      |

|Work Phone: |      |Hours: |      |

|Cell Phone: |      | | |

|Interviewed: | Yes No |

Victim Information

Are you or any other members of your household acquainted with [victim(s)] who live at [crime scene]?

|      |

How well do you/they know them?

|      |

Who else resides at the (victim’s) address?

|      |

What sort of reputation do each of them have in the neighborhood?

|      |

Have you ever been inside the [crime scene]? If yes, when were you there last?

|      |

Are you familiar with any daily routines at [crime scene]?

|      |

Who was closest to [victim(s)] or other occupants?

|      |

Do you know of anyone who may have visited [victim(s)/crime scene] recently?

|      |

When/where was the last time you saw [victim(s)] or any other member of their household?

|      |

ISSUES SURROUNDING VICTIM

Are you aware of any problems involving [victim(s)/crime scene]?

|      |

Were [name] and [name] having problems in their relationship, at work or in some other way?

|      |

Was there anyone the victim was afraid of or upset with?

|      |

Does either [name] or [name] have enemies that you know of? If yes, get details.

|      |

Are you aware of any person(s) who would wish to harm the victim and his/her family? If so, please provide details.

|      |

Is there anyone you think might do something like this? (who/why)

|      |

How long have you lived at this address?

|      |

How long has the victim(s) lived at that address?

|      |

Did anyone move into or out of the victim(s) residence recently?

|      |

Neighborhood Information

What time is the mail delivered in the neighborhood?

|      |

What time is the newspaper delivered in the neighborhood?

|      |

Did you observe any service people in the neighborhood today or recently? (meter readers, repair persons, deliveries, etc.)

|      |

Have there been any neighborhood events such as garage sales, parties, or other unusual events in recent weeks?

Garage Sales/Estate Sales Parties/BBQs

Carnivals/Fairs/Parades People Moving In/Out

Open Houses Flea Markets/Farmers Markets

Social Group Meetings Sport Leagues/Games

Other

What is the usual daily activity in this area (day and night)?

|      |

Did you observe anyone/anything out of the ordinary today or in the recent past?

|      |

Have you felt uneasy about anything in the neighborhood recently?

|      |

Did you or any other member of your household have occasion to go by [crime scene] today or in the recent past?

|      |

Do you recall seeing anyone in the vicinity of [crime scene] between [estimated time of incident]?

|      |

Did anyone stop at your residence today? (who/when/why)

|      |

Does your home have an exterior surveillance system?

|      |

Are you aware if your neighbors have video or camera surveillance?

|      |

Do you or your neighbors have dogs? Did they bark? At what time?

|      |

Did you see any vehicles parked near [address]?

|      |

Has anyone in the neighborhood been a victim of a crime in the past year? (any suspects)

|      |

Is there anyone in the neighborhood who has been arrested or has had other negative police contacts?

|      |

SOCIAL MEDIA

Are you aware of anyone who may have information or evidence relating to this incident? If so, please provide details.

|      |

Have you seen or heard of any social media posts, blogs or other mentions on line about this incident?

|      |

Additional Information

What were your activities during [estimated time of incident]? Who was with you?

|      |

If appropriate, obtain consent to search the residence, vehicles, storage areas. (If consent obtained, attach consent to search forms to interview sheet.)

Consent to Search Obtained: Yes No

Name of Person Who Consented:      

Areas Searched:

House Garage/Carport

Cars/Trucks Sheds/Outbuildings

Boats Trailers/RVs

Other

The best time to contact other residents who were not present at the time of this contact?

|      |

Is there anything else that you can tell me that may be beneficial to this investigation?

|      |

***THIS DOCUMENT IS INTENDED FOR NOTE TAKING PURPOSES ONLY.

A DICTATED/TYPEWRITTEN REPORT SHOULD STILL BE COMPLETED

COVERING THE INFORMATION CAPTURED ABOVE***

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