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VOLUNTARY WITNESS STATEMENT FORM CLARK COUNTY PUBLIC RESPONSE OFFICE 2911 E SUNSET RD, LAS VEGAS, NV 89120 Phone: 702-455-4191 – Fax: 702-455-2080 PublicResponseInfo clarkcountynv.gov CASE NUMBER: OFFICER: CE : DATE OF INCIDENT: NATURE OF INCIDENT – INCLUDE ADDRESS OR LOCATION PAGE OF WITNESS NAME: DATE OF BIRTH: ADDRESS: PHONE NUMBER: WITNESS SIGNATURE: DATE: Your name, date of birth, address, and telephone number are requested in case additional information is needed or if you are needed for a court appearance pertaining to this case..
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