Page 80 - Main Second Asbo Book1

I Form MG11
RESTRICTED (when complete)

WITNESS STATEMENT

(CJ Act 1967, s.9; MC Act 1980, ss.5A(3) (a) and 5B; MC Rules 1981, r.70)

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Age if under 18 ... ~ . ~ ....... (if over18 insert 'over 18')
This statement (consisting of ..... ::l,,, .............. page(s) each signed by me) is true to the best of my knowledge
and belief and I make it knowing that, if it is tendered in evidence, I shall be liable to prosecution if I have wilfully
stated in it anything which I know to be false or do not believe to be true.
Tick if witness evidence is visually recorded O (supply witness details on rear)
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Signature .~ ,/._ ~ ~rt.z:. Signature witnessed by ....... . . ....... . .. .......... . .... ..... .. .......... ........... .... .
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