Affidavit Witness Statement Form
State
County
Notary Public
Title and Rank
Date of Commission Expiry
-
Month
-
Day
Year
Date
Witness
Current Legal Name
First Name
Last Name
Current Occupation
Age
Current Address of Residence
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Accused
Current Legal Name
First Name
Last Name
Current Occupation
Age
Current Address of Residence
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Incident
Location of Incident
Physical Address of the Incident Place
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Date and Time of Incident
-
Month
-
Day
Year
Date
Hour Minutes
AM
PM
AM/PM Option
Please attach the necessary documents related to the incident.
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Statement of Witness:
Date
-
Month
-
Day
Year
Date
Signature of Witness
Submit
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