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VICTIM/WITNESS STATEMENT FORM
Victim/Witness_______________________Date_______________Time________Case Number_______
Interviewer_______________________________________Location_____________________________
Witness:______________________________________Witness:_________________________________
I,________________________, Do hereby make the following statement regarding the Crime /
Incident I was a victim Of / Witness to on_____________________. I understand that it is an ethical
violation to make a sworn statement that contains false information and that I could be reprimanded
by the Charlotte County Soccer Federation for doing so. I declare that the following information is
the truth to the best of my knowledge.
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