Fillable WITNESS STATEMENT (Testimonio Escrito) (Syracuse City)

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WITNESS STATEMENT (Testimonio Escrito) (Syracuse City)

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WITNESS STATEMENT (Testimonio Escrito)
CASE # (Numero de Caso)
DATE OF BIRTH(Fecha de Nacimiento)
Pursuant to Rule 1102, Utah Rules of Evidence and Section 76-8-504.5, Utah Code Annotated:
You are notified that statements you are about to make in this document may be presented to a magistrate
or a 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.
Conforme a la regla 1102, de evidencia de Utah y la seccione 76-8-504.5, del codigo de Utah anoto:
Le notifican que las declaraciones que usted esta a punuto de hacer en este documento se pueden presentar
a un magistrado o a un juez en lugar de su testimonio jurado en una examinacion preliminar. Cualquier
declaracion falsa que usted haga y que usted no crea que sea verdadero, usted puede ser sujeto a un castigo
criminal como delito menor de clase A.
I understand the above statement (Entiendo la declaracion antedicha)
Signature (Firma) Date (Fecha)
STATEMENT (Testimonio)
Continue on back side (Continuar en el reverse)
STATE (Estado) ZIP (Codigo Postal)
CELL PHONE (Teléfono Móvil)
NAME (Nombre)
ADDRESS (Domicilio)
CITY (Ciudad)
HOME PHONE (Teléfono de Casa)
BUSINESS PHONE (Teléfono de Trabajo)
EMAIL (Correo Electrónico)
EMERGENCY CONTACT (Contacto de Emergencia)
LOCATION OF INCIDENT (Ubicación de Incidente)
DATE OF INCIDENT (Fecha de Incidente)
PHONE (Teléfono)
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WITNESS STATEMENT (Testimonio Escrito) (Syracuse City)

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Completed 24 January 2021

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