VOLUNTARY STATEMENT

117 E. Main Street

Bokchito, OK 74726

(580) 775-3589 Fax (580) 295-3777
VOLUNTARY STATEMENT
Today's Date

MonthDayYear
Date
Current Time
Location
Full Legal Name
Date of Birth
Sex
Social Security Number
DL #
Phone
Race
Address (City, State, Zip)
Height
Weight
Hair Color
Eye Color
Marital Status
Incident Date

MonthDayYear
Date
Incident Time
Location
I understand that I am not under arrest nor am I being detained for any reason. The following statement is given voluntarily and I may stop at any time. I also understand that if anything I say and/or write incriminates me, I will be subject to arrest:
I have read this statement consisting of
page(s) and the facts contained therein are true and correct.
Signature of Person Giving Voluntary Statement

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Page
of
VOLUNTARY STATEMENT
(Continued)
Signature of Person Giving Voluntary Statement

Clear
of
of
Should be Empty: