Affidavit Statement
Affidavit Statement
This affidavit statement is a written declaration made under oath, affirming the truthfulness of the information provided. The undersigned is aware of the serious nature of providing false information and acknowledges responsibility for the veracity of the contained statements.
Personal Information
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Name: |
John Doe |
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Date of Birth: |
January 1, 2050 |
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Address: |
123 Main Street, Anytown, USA |
Statement of Facts
Incident Description
On July 15, 2050, I, John Doe, was involved in an incident at the intersection of 5th Avenue and Main Street. As I was driving through the intersection, another vehicle ran a red light and collided with the passenger side of my car.
Details of Incident
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Date: July 15, 2050
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Time: 3:00 PM
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Location: 5th Avenue and Main Street
Witnesses
There were two witnesses to the incident:
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Jane Smith, 456 Oak Street, Anytown, USA
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Robert Brown, 789 Pine Avenue, Anytown, USA
Additional Information
The responding police officers prepared a report which documents the sequence of events and includes statements from both drivers and the witnesses.
[Your Name]
[Date]
