Page 81 - Main Second Asbo Book1

RESTRICTED (when complete) Form MG11

WITNESS STATEMENT

(CJ Act 1967, s.9; MC Act 1980, ss.5A(3)(a) and 5B; Criminal Procedure Rules 2005, Rule 27.l)

URN

Statement of..,_

Age if under 18 .. Q'!..~~~·-·· (if over18 insert 'over 18') Occupation .. ,

This st?tement (con~isting ~f ·--·--.. ·:·-:'"·:--Page(s) ea~h si~ned by me) is true to the best of my knowledge
and belief and I make 1t knowing that, 1f 1t 1s 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.
' '
Signature . ·,...---~·-··•--. ..,--,,.- ___ ____ Date ---~_j_2._ 5 _{ ?p __ l4----'-----
0

..
Signature witnessed by ........... .. Jll.~ ..P?:· ... ?:.~ f .. ~ ................ · LI
..
.
i
Signature ........... . ...........................
1• II II II II II.JUI u u II II -•·•'·•••,1•.H.ll.}I, •u• ii 11_-1 .. 11 i1JJ_11_1vv•,1-•
rl'.Y.-. .. -.-•• .,. .... -.,.. II !I • .--.-.•.-.-.• ....... -..-.-.-.•'
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