Sworn Statement Form

Sworn Statement Form
The purpose of this form is to collect and document potential criminal activities involving the Army so that Army officials can maintain law, order and discipline by investigating the statements.
Location
File Number
Date
YearMonthDay
4 digit year, 2 digit month, 2 digit dayDate
Time
Hour Minutes
AM/PM Option
Name
First NameMiddle NameLast Name
Grade/status
Address
Street Address
Street Address Line 2
CityState / Province
Postal / Zip Code
I, {name}, would like to make the following statement under oath
I, {name}, agree with the following statements
Date
MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Signature of the Person Making The Oath
Clear
Witness Name
First NameLast Name
Witness Signature
Clear
Name of the Person Administering the Oath
Prefix (Authority)First NameLast Name
Signature of the Person Administrating Oath
Clear
Should be Empty: