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US Jail Death Entry - NM Homicide
Help NM Homicide create a more complete database of all the deaths in jails
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Subject's name *
Subject's age
Subject's gender *
Subject's race
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Date of death (month/day/year)
MM
/
DD
/
YYYY
Facility where injury occurred *
For example, the Santa Fe County Jail or the Tierra Amarilla Detention Center or the Penitentiary of New Mexico
Location of death (state)
10. Location of death (zip code)
Zip codes are easy; just plug the street address, city and state into Google Maps, and it will tell you the zip code.
Location of death (address)
Where the person died. Input this if the person did not die in the facility where the injury occurred. For example, if someone died at a local hospital.
Location of death (county)
County where the person died. If the county of death is different than the county where the person was injured, input both, and say which is which.
Agencies responsible for death
Please, no abbreviations, the whole name in title case: Albuquerque Police Department or Santa Fe County Detention Center. This may have multiple answers, including healthcare providers
Did the victim die after being released?
Was the victim released just prior to dying?
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A brief description of the circumstances surrounding the death
Brief, please. Like 70 words. Only one paragraph with no returns
Has a lawsuit been filed? If so, please include the case number, the court and if it is in state or federal court
Link to news article or photo of official document *
Symptoms of mental illness?
Were there obvious signs of sickness, like suicidal threats, or were law enforcement called by the family to aid with a mentally ill family member?
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Symptoms of mental illness?
Were there obvious signs of sickness, like suicidal threats, or were law enforcement called by the family to aid with a mentally ill family member?
Agency investigating the death?
5. URL of image of deceased
You know how to do this? Keep clicking the picture until you have the largest image possible, then right-click on it and select "Copy image URL" and paste it into the field. Careful with this, guys; fact-checkers keep finding officers' pictures instead of the dead person's.
Did you know the victim and are you willing to be interviewed? If not, are you willing to be contacted for follow-up information gathering? If so, please include your name and contact information.
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