Da Form 2823 - Sworn Statement Page 3
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1
2
3STATEMENT OF
TAKEN AT
DATED
9. STATEMENT
(Continued)
AFFIDAVIT
I,
, HAVE READ OR HAVE HAD READ TO ME THIS STATEMENT
WHICH BEGINS ON PAGE 1, AND ENDS ON PAGE
. I FULLY UNDERSTAND THE CONTENTS OF THE ENTIRE STATEMENT MADE
BY ME. THE STATEMENT IS TRUE. I HAVE INITIALED ALL CORRECTIONS AND HAVE INITIALED THE BOTTOM OF EACH PAGE
CONTAINING THE STATEMENT. I HAVE MADE THIS STATEMENT FREELY WITHOUT HOPE OF BENEFIT OR REWARD, WITHOUT
THREAT OF PUNISHMENT, AND WITHOUT COERCION, UNLAWFUL INFLUENCE, OR UNLAWFUL INDUCEMENT.
(Signature of Person Making Statement)
Subscribed and sworn to before me, a person authorized by law to
WITNESSES:
administer oaths, this
day of
,
at
ORGANIZATION OR ADDRESS
(Signature of Person Administering Oath)
(Typed Name of Person Administering Oath)
ORGANIZATION OR ADDRESS
(Authority To Administer Oaths)
INITIALS OF PERSON MAKING STATEMENT
PAGE
OF
PAGES
APD LC v1.01ES
DA FORM 2823, NOV 2006
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