Ricky W. Morris, Jr. P.C.

Attorneys at Law

WITNESS STATEMENT FORM

State of Georgia vs. _______________________

Name: _______________________________________________________________________

Address: ______________________________________________________________________

Date of Birth: ________________ Social Security: ____________________________________

Race: ________ Sex: _________ Height: __________ Weight: __________

Employer: ____________________________________________________________________

Address: ______________________________________________________________________

Home:______________________ Work:___________________ Cell:____________________

****Details (Who, What, When, Where, Why, How) Sign & Date upon completion.

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Date: _________________ Signature: _______________________________________

Witness Statement, Continued Page _____ of ______

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Signature: _______________________________________