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TIZEN STATEMEN
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DATE REPORTED DATES OCCURRED TIMES OCCURRED DAY DISPOSITION YEAR INCIDENT NUMBER
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PERSON’S NAME (LAST, FIRST, MIDDLE, SUFFIX) DATE OF BIRTH
PERSON’S ADDRESS, CITY, STATE, ZIP CODE
RACE SEX HEIGHT WEIGHT EYES HAIR HOME PHONE DAY / WORK PHONE CELLULAR PHONE
CITIZEN STATEMENT
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INVESTIGATING OFFICERS
BADGE NUMBERS
Waterford Police Department
5150 Civic Center Drive
Waterford, MI 48329
www.waterfordmi.gov/police
Business: (248) 674-0351
Fax: (248) 673-5190
CITIZEN SIGNATURE