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WHITEFISH POLICE DEPARTMENT VOLUNTARY STATEMENT Time Statement Started a.m./p.m. Date Place D.O.B. Name Sex Hair Eyes S.S.N. Place of Birth (City, State) Address City State Zip Home Phone Work Phone Workplace I do hereby make the following statement to he/she having first identify himself/herself as a WHITEFISH POLICE OFFICER, knowing that I may have an attorney on my behalf present and that I do not have to make any statement not incriminate myself in any manner. I make this statement voluntarily, of my own free will, knowing that such statement could later be used against me in any court of law, and I declare that this statement is made without any threat, coercion, offer, or benefit, favor or offer of favor, leniency, or offer of leniency by any person or persons whomsoever. Signature of Author SIGN