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Witness Statement

Below is my statement regarding the incident which occurred on:

Date:

___________________________________________

Time:

___________________________________________

Location:

___________________________________________

Statement:

___________________________________________
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___________________________________________
___________________________________________
___________________________________________
___________________________________________
___________________________________________
___________________________________________
___________________________________________
___________________________________________
___________________________________________

Name:

___________________________________________

Address:

___________________________________________

Phone #:

___________________________________________

Work #:

___________________________________________

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Wake Forest
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