Witness Statement Form
RUMFORD POLICE DEPARTMENT
Your full name
Date of birth
Your street address
(Example: 124 Main Street, Apt. 4)
Do you acknowledge and agree with this disclaimer?
I hereby acknowledge that I am making the following statement without fear, threat, or promise. I acknowledge that I have been advised that any statement(s) made herein which I do not believe to be true, and which statement is intended to mislead a public servant in the performance of his/her official duties is a crime under 17-A M.R.S.A., section 453.
I acknowledge and agree with the disclaimer
I do not acknowledge or agree with the disclaimer
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