The Crime Reporting Unit, in conjunction with the Criminal History Systems Board, shall assure that no disclosure of Criminal Offenders Record Information subject to M.G.L. c. 6, §§ 167 through 178 is made otherwise than in accordance with the provisions of said statute. Names of victims and perpetrators of hate crimes should not be reported to the Crime Reporting Unit on the prescribed form, in the course of the hate crimes data reporting. Crimes shall be referenced and identified by the case number assigned by the reporting agency, the time and date of the incident, and other particularized information.

REGULATORY AUTHORITY

501 CMR 4.00: M.G.L. c. 22C, § 33.

EXHIBIT A

MASSACHUSETTS HATE CRIME REPORTING FORM

Agency Name: ORI:__________ Case #

Date most recent incident:________ Time (military format)__________

Revision of previously submitted report? ___Yes ___No If YES, original case#:______________

Location of offense: ___________

1-Person(s) 2-Private Property 3-Public Property 4-Religious

Target of Hate Crimes: (circle all that apply)

facility 5-Other, describe:________________

1–Spray painted Hate symbols/language 2-Verbal harassment/slurs

Bias Indicators (circle all that apply)

3-Damage to prop 4-Threatening mail 5-other, describe:__________

Indication of Organized Hate Group? ___Yes ___No (describe in narrative)

Prior bias incidents to this victim at this location? ___Yes ___No (describe in narrative)

1-Gun 2-Knife/cutting 3-Stick/club 4-Rocks/bricks

Weapon Used: (circle all that apply):

5-Hands/feet 6-Other__________ 7-None

check check check

Race/Eth check Religious S exual check Handicap Gender 11 Black 21 Jewish 41 Gay(male) 51 M ental 61 M ale 12 White 22 Catholic 42 Lesbian 52 Physical 62 Female

63 Anti-

13 Asian 23 Protestant 43 Other___ 52 AIDS

Transgender

14 Hispanic 24 Islamic 53 Other___ 15 Arab 25 Other___

C heck all that apply 16 Other___

Court order or

Victim Age Race S ex Inj Perp Age Race S ex Arrest?

injunction granted

No #1 M /F No #1 M /F Y/N No #2 M /F No #2 M /F Y/N No #3 M /F No #3 M /F Y/N If other victims, total #__________ If other perps, total #____________

Damage Disorderly

1 Vandalism 2 3 Harassment 4 5 Trespass

Relig Obj Person

Weapons

4 Threats 7 Property Damage 8 9 Sex Offenses 10 Arson

Offense

Aggravated

11 Simple Assault 12 Larceny Theft 13 Burglary 14 15 Robbery

Assault

C hec k all that apply General Civil 16 Rape 17 M anslaughter 18 M urder 19

Rights

Narrative (attach additional sheets as necessary ) IF ZERO REPORTS, CHECK:______

Filed out Chief’s by:_________________________ signature:_____________ Date:______

EXHIBIT B