BUNKER HILL COMMUNITY COLLEGE
POLICE DEPARTMENT
250New Rutherford Ave., E-127 Charlestown MA. 02129-2925
Phone 617-228-2053
VOLUNTARY STATEMENT FORM
Please fill out the form below. Use additional pages for your statement if needed. Provide your name on each page. Once completed PRINT OUT all pages of the statement form, staple together and submit to BHCC Public Safety Office Room E-127, Charlestown Campus or Room 107, Chelsea Campus.
I, _______________________________________, volunteer the following information of my own freewill, for
whatever purposes it may serve, to Officer ___________________ of the Bunker Hill Community College Police
Department. I am _____ years old and was born on _____________. I reside at: ________________________________
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My phone number is: ____________________________
VOLUNTARY STATEMENT
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I have just read each page of this statement, consisting of ___ page(s), each page of which bears my signature,
and corrections, if any, bear my initials, and I certify that the facts contained herein are true and correct to my knowledge. This ___________ day of _______________, 20_____
Person Giving Statement: __________________________________
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OFFICE USE ONLY |
Incident #__________________________ |
Intake Officer:______________________ |
BUNKER HILL COMMUNITY COLLEGE
POLICE DEPARTMENT
250New Rutherford Ave., E-127 Charlestown MA. 02129-2925
Phone 617-228-2053
VOLUNTARY STATEMENT CONTINUATION
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Person Giving Statement: __________________________________
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OFFICE USE ONLY |
Incident #__________________________ |
Intake Officer:______________________ |