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THIS FORM MAY BE SAVED TO Lake Placid Police Department YOUR COMPU

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Florida Witness Statement Form document sample

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									                                                                                THIS FORM MAY BE SAVED TO


                       Lake Placid Police Department                           YOUR COMPUTER THEN TYPED.
                                                                                PLEASE PRINT THE FORM AND
                                                                                  HAVE A NOTARY OR LAW
                                                                               ENFORCEMENT WITNESS SAME
                        8 North Oak Avenue Lake Placid, FL 33852-9546          THEN MAIL OR DELIVER TO LAKE
                                                                               PLACID POLICE DEPARTMENT, 8
                            863-699-3759 ! FAX 863-699-3760 www.lppd.com         NORTH OAK AVENUE, LAHKE
                                                                                      PLACID, FL. 33852
                                                                               NOTE: THIS BOX WILL NOT PRINT

                            VOLUNTARY STATEMENT FORM
Case #: _________    Date / time occurred: _____________ Date / time of statement: _____________

Incident Location: _______________________________ Statement given to: (Officer): ____________

Witness Name: __________________________ Witness Address: ____________________________
Witness Telephone Number(s): ________________________________________________________

                  OTHER MEANS OF CONTACTING WITNESS IN FUTURE:
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                             SWORN STATEMENT
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________________________________________________________CONTINUE ON BACK
                                     DAMAGES SUMMARY
The estimated dollar amount of damages suffered from this event are:
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                                             AFFIRMATION
I have read this statement consisting of ____ page(s) and hereby swear or affirm that the facts
contained herein are true and correct to the best of my belief.
WITNESS NAME PRINTED AND SIGNED:________________________________________________
DATE SIGNED: ________________ OFFICER WITNESS TO SIGNATURE: _____________________
                                                                                Page _____ of _______
                           SWORN STATEMENT CONTINUED
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WITNESS INITIAL _________________                         Page ______ of __________

								
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