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Sample Police Witness Statement Template (For Reference Only)
See a clear, fact-based format for describing what you witnessed in a police statement with this reference template.
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Sample Police Witness Statement Template (For Reference Only)
Important: This sample is for formatting/reference only. Use only truthful information based on your personal knowledge.
Statement Date: [Date]
Agency/Case Number (if known): [Case #]
Officer/Investigator (if known): [Name/Badge #]
1. Witness Information
1.1 Full Legal Name: [First Name Last Name]
1.2 Date of Birth (Optional): [MM/DD/YYYY]
1.3 Address: [Full Address]
1.4 Phone/Email: [Contact Information]
1.5 Occupation (Optional): [Occupation]
1.6 Preferred Method/Time to Contact (Optional): [Details]
2. Incident Information
2.1 Date of Incident: [MM/DD/YYYY]
2.2 Approximate Time: [Time] (☐ AM ☐ PM)
2.3 Location: [Address / Description of location]
2.4 Type of Incident (Optional): [Assault / Theft / Accident / Disturbance / Other]
2.5 People Involved (If Known): [Names / Descriptions]
2.6 Other Witnesses (If Known): [Names / Descriptions]
3. What I Personally Observed
3.1 Where I Was. [Explain where you were positioned and what you were doing right before the incident.]
3.2 What I Saw. [Chronological description of events you directly saw.]
3.3 What I Heard. [Exact words if remembered; otherwise summarize clearly.]
3.4 What Happened Next. [What occurred immediately after, including any separation, vehicles leaving, calls to police, etc.]
3.5 Descriptions (If Applicable).
Person #1: [Height/build/clothing/hair/identifying features]
Person #2: [Height/build/clothing/hair/identifying features]
Vehicle(s): [Make/model/color/plate/decals/direction of travel]
4. Actions I Took
4.1 Immediate Actions. [Called 911, helped someone, moved to safety, spoke to security, etc.]
4.2 Medical Assistance (If Any). [What you observed/did.]
4.3 Prior Knowledge (If Any). [Only if personally known: relationship to anyone involved.]
5. Evidence and Attachments (Optional)
5.1 I can provide the following evidence (if any):
Exhibit A: [Photo/video]
Exhibit B: [Screenshot/text message]
Exhibit C: [Other]
6. Reference Sample Narrative (Example Only)
Replace the text below with your own facts.
6.1 “On [Date] at approximately [Time], I was standing near [Location]. I saw [Person] approach [Other Person]. I heard [quote or summary]. I then saw [specific action]. After that, [what happened next]. I did not see [anything you did not witness], and I left the area at approximately [Time] when [reason].”
7. Statement of Truth
7.1 The information above is true and correct to the best of my knowledge and is based on what I personally observed.
Signatures
Witness: [Full Legal Name]
Date: [Date]
Signature: ___________________________
Notary / Notarization (Optional)
Subscribed and sworn (or affirmed) before me on [Date], by [Witness Full Legal Name], who is personally known to me or has produced identification.
Notary Public Signature: _______________________
My Commission Expires: _______________________
Notary Seal (if applicable): ___________________
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Learn more about
Sample Police Witness Statement Template (For Reference Only)
Click below for detailed info on the template.
For quick answers, scroll below to see the FAQ.
Click below for detailed info on the template.
For quick answers, scroll below to see the FAQ.
SAMPLE POLICE WITNESS STATEMENT TEMPLATE FAQ
What is a police witness statement?
A police witness statement is a written account of what a person personally saw, heard, or experienced related to an incident. It is used by law enforcement to understand timelines, identify people involved, and document facts for an investigation.
What should a police witness statement include?
It usually includes your identifying information, the date/time/location of the incident, who was involved (if known), a chronological description of what you observed, and any evidence you have (photos, video, messages). Keep it factual and separate what you know from what you assume.
Should you include opinions or guesses?
It’s best to focus on facts. If you include impressions (like “he seemed intoxicated”), explain what you observed that led to that impression (slurred speech, stumbling, odor of alcohol). Avoid repeating rumors or assumptions as facts.
How detailed should the timeline be?
As detailed as you can honestly provide. If you’re not sure about times, say “approximately” and relate events to clear markers (e.g., “right after the store closed,” “before the bus arrived”).
Should you sign or notarize it?
Police statements are usually signed. Notarization is not always required, but some situations may request a sworn statement. This template includes an optional notarization section if needed.
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