AFFIDAVIT on an “Official Contact”
Give a simple written account of the law enforcement incident(s) in which you were involved 
as a party or witness.  State the location, date, and time of the “Official Contact”, and what you 
were doing when it occurred.  Describe the full course of the incident, with careful details of the
actions & statements made.  Provide names, agencies, & badge numbers of  the Officials involved, 
and identify other parties & witnesses to the incident, with addresses & contact info at the bottom.  
State what YOU know or observed... reports from known sources can be noted, but unconfirmed 
hearsay is not useful.  If you need more space, use the backside or additional pages.
____..____..____..____..____..____..____..____..____..____..____

I, the undersigned ____________________________________________, attest:

____..____..____..____..____..____..____..____..____..____..____
	I declare under the penalties of perjury pursuant to 28 U.S.C. 1746 
	  that the above statements are true.

	Signed:_________________________________________     	______________
	      Name...								         Date
	   Address,
	  Contact #...

    Witnessed: