NORTH EAST I.S.D. POLICE DEPARTMENT
AFFIDAVIT TO ANY FACT
CASE NO:
PAGE:
THE STATE OF TEXAS
COUNTY OF BEXAR
Time of Statement:
Date of Statement:
OF
BEFORE ME, THE UNDERSIGNED, on this day personally appeared
to me well known, and who deposes and
says that, I am
years of age. My date of birth is
. I currently reside at
, City
, State
, Zip Code
. My home phone number is
. I am employed by
. My work phone number is
. I certify that I can
read, write and understand the English language. (Initial) _____
This statement is in regards to an incident which occurred on or about the
approximately
o’clock
.M., the facts of which are stated below.
day of
, 20
at
______________________________
SIGNATURE OF AFFIANT
Sworn to and subscribed before me this
day of
, 20
_____________________________
Notary Public in and for the
State of Texas