Statement Form "*" indicates required fields Case #*Officer Taking Statement* First Last Name* First Last Date of Birth* MM slash DD slash YYYY Time* Hours : Minutes AM PM AM/PM Address* Street Address City State / Province / Region ZIP / Postal Code Phone*Email* NO PROMISES OR THREATS HAVE BEEN MADE TO ME AND I REALIZE THAT I DO NOT HAVE TO MAKE ANY STATEMENT IF I DO NOT WANT TO. I KNOW THAT I HAVE A RIGHT TO TALK TO AN ATTORNEY BEFORE MAKING AND STATEMENTS AND THAT ANY STATEMENT I MAKE CAN BE USED AGAINST ME IN A COURT OF LAW. PLEASE MAKE YOUR STATEMENT AS DETAILED AS POSSIBLE.* I agreeStatement* Δ
