1-704 Supplementary Homicide Report

1-704 (Rev. 01-12-11)

SUPPLEMENTARY HOMICIDE REPORT

OMB No. 1110-0002

This report is authorized by law Title 28, Section 534, U.S. Code. While you are not required to respond, your cooperation in using this form to list data pertaining to all
homicides reported on your 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.

Offender**
Age
Sex
Race
Ethnicity

Age
Sex
Race
Ethnicity

Incident
Situation*

Victim**

Data Code

Relationship of Victim
to Offender
Weapon Used
(Husband, Wife, Son,
Do Not Write (Handgun, Rifle, Shotgun, Father, Acquaintance,
In These Spaces
Club, Poison, etc.)
Neighbor, Stranger, etc.)

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

*
** - See reverse side for explanation

Month and Year

Agency

Agency Identifier

Prepared by / E-mail address

State

Title

DO NOT WRITE HERE
Recorded
Edited
Entered
Verified
Adjusted

Sheriff, Chief, Superintendent, Commanding Officer
FBI/DOJ

SUPPLEMENTARY HOMICIDE REPORT (Continued)

Victim**

Offender**

Age
Sex
Race
Ethnicity

Age
Sex
Race
Ethnicity

Incident
Situation*

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.

* - Situations

Data Code

Relationship of Victim
to Offender
Weapon Used
(Husband, Wife, Son,
Do Not Write (Handgun, Rifle, Shotgun, Father, Acquaintance,
Knife, etc.)
Neighbor, Stranger, etc.)
In These Spaces

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

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 or African American - B, American Indian or Alaska Native - I, Asian - A, Native Hawaiian or Other Pacific Islander - P, Unknown - U.
Use only these as race designations.

Ethnicity - Hispanic or Latino - H, Not Hispanic or Latino - N, Unknown - U.