Page Police Department | Field Witness Statement

* Required field

Date *

DR # Police use only

Witness Name *

Date of Birth *

Home Phone #

Cell Phone # *

Work Phone #

Home Address/ P.O. Box *

City and State *

Time and Date of Incident *

Location *

Victim Name (if known)

Suspect Name (if known)

Description of Suspect/Victim *

Vehicle Description *

Statement of Witnessed Actions (Describe in detail exactly what you witnessed. Begin with date, time and location. Then list what happened in chronological order. Please write legibly.) *

Receiving Officer

Time/Date

Location

Please confirm your signature by typing your full name in the box below.

I agree this is a legal representation of my signature for all purposes just the same as a pen-and-paper signature.