SKAGIT COUNTY SHERIFF’S OFFICE WITNESS STATEMENT FORM
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Deputy Handling Case (If Known)____________________
Name________________________________________Address_______________________________
I am_______years old. My date of birth is____________. My phone number is (____)_____________
I have finished the___grade in school. I can read, write and understand the English language__yes __no.
Be sure to sign and date the bottom of the statement form.
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The above information is true to the best of my knowledge and was freely given. No threats or promises have been made
against or to me in order to get me to make this statement. I certify under the penalty of perjury under the laws of the State of
Washington that the foregoing is true and correct.
Signed_______________________________________Date_____________________Time______________
Witness______________________________________Date_____________________Time______________
___DO NOT DISCLOSE Page______of_______