403.5E2 - Witness Disclosure Form

Name of witness:   _________________________________________________________

Position of witness:   _______________________________________________________

 Date of testimony, interview:  ________________________________________________

 Description of instance witnessed:  ____________________________________________                                   

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Any other information:  _______________________________________________________

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I agree that all of the information on this form is accurate and true to the best of my knowledge.

 

Signature: ___________________________________                                            

Date: _______________________________________