Witness Statement
Fill in the bracketed sections, print, sign in blue or black ink, and deliver to the attorney or injured party. Keep a copy for yourself.
I, [full name], of [city, state], provide this statement voluntarily regarding an incident I personally witnessed on [date] at approximately [time].
Location:
[exact intersection or address, city, state]Weather / Conditions:
[e.g., clear skies, dry pavement, daylight]What I Observed:
I was [describe your position]. At approximately [time], I observed
After the Incident:
e.g., “I pulled over and called 911 at [TIME]. I spoke with Officer [NAME / BADGE #] at the scene.”
Declaration
I declare under penalty of perjury under the laws of the State of [state] that the foregoing is true and correct to the best of my knowledge and recollection.
Signature
Date
Printed Name
Phone