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

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THIS FORM MAY BE SAVED TO Lake Placid Police Department YOUR COMPU Powered By Docstoc
					                                                                                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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posted:11/14/2010
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Description: Florida Witness Statement Form document sample