Sheriff James O. Tracy
VOLUNTARY STATEMENT
Name:__________________________________ Date: Case Number:
Home Phone: Cell Phone: Work Phone:
Address:__________________________________ City:________________ State:____ Zip:__________
DOB: SS #:________________ Drivers License #: Page of
Notice: Pursuant to Section 76-8-504.5, Utah Code Annotated, 1953 as amended, you are notified that
statements you are about to make may be presented to a magistrate or judge in lieu of your sworn testimony
at a preliminary examination. Any false statement you make and that you do not believe to be true may
subject you to criminal punishment as a Class A Misdemeanor.
I do give this statement of my own free will. I understand that I have the right to remain silent, that anything
I say can be used against me in a court of law, that I have the right to talk to an attorney, and to have him
present when I make this statement, that if I cannot afford an attorney one will be appointed for me if I so
desire. I understand that I have the right to stop answering questions at any time.
Fully understanding the rights above I make the following statement
.
(Signature) (Witness)
VOLUNTARY STATEMENT (CONTINUED)
