University of Minnesota Duluth
 
 

 UMD Police Department

Voluntary Statement Form: I am not under arrest for, nor am I being detained for any criminal offense. I am willing to make a statement concerning the following event(s) to the UMD Police Department. Without being accused of or questioned about any criminal offenses regarding the facts I am about to state, I volunteer the following information of my own free will for whatever purpose it may serve. (* marked fields are required)
Your Information - Person requesting services.
 
* Full Name :
* Date of Birth :  (MM/DD/YYYY)
* Phone :  (xxx-xxx-xxxx)
* Email:  
*Local Address:
*Case Number
*Nature of the Incident
*Voluntary Statement
* Please Select the Officer that is assisting you.

   
         
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Last modified on 07/03/12 11:52 AM
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