Voluntary Statement Form - North Pole Police Department

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VOLUNTARY  STATEMENT 
North Pole Police Department 
CASE # _______________________ 
DATE: ____________________ 
Last Name 
First Name 
Middle Name 
Phone # 
Street Address 
City 
State 
Zip Code 
Driver’s License # 
State 
APSIN ID 
SSN 
Date of Birth 
Place of Birth 
State/Country of Birth 
I, ___________________________________________, make the following voluntary / signed statement: 
_____________________________________________________________________________ 
_____________________________________________________________________________ 
_____________________________________________________________________________ 
_____________________________________________________________________________ 
_____________________________________________________________________________ 
_____________________________________________________________________________ 
_____________________________________________________________________________ 
_____________________________________________________________________________ 
_____________________________________________________________________________ 
_____________________________________________________________________________ 
_____________________________________________________________________________ 
_____________________________________________________________________________ 
_____________________________________________________________________________ 
_____________________________________________________________________________ 
_____________________________________________________________________________ 
_____________________________________________________________________________ 
_____________________________________________________________________________ 
I have read the above and foregoing statement and have been given the opportunity to make any corrections 
or changes I may want to make. And changes I have made are initialed by me in my own handwriting. 
Signature _______________________________________________ Date __________________
Page ______ of _______ 

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