Midwestern State University Police

Affidavit Instructions

Upon completion, your affidavit will be a written statement of facts, voluntarily made, under oath

or affirmation, administered by a person authorized to do so by law (a police officer or notary).

1. Fill in the day, month, year, and time you started writing this affidavit at the top of the form just

under the double line. Put your name after “personally appeared.”

2. Use your full legal name and your date of birth. Use your local address or your local post office box

number with proper zip code.

3. Write, in your own words, what happened, in chronological order.

THINGS THAT ARE IMPORTANT: First and last names, dates, times, serial numbers, model

numbers, telephone numbers including area codes, PO box numbers, age of persons, description of

persons, vehicle license plate numbers, vehicle description, inside/outside vehicle color, etc. If a

theft occurred, list all items stolen and what you paid for that item. Be as specific and descriptive as

possible. Remember the more you can give the police, the more the police will have to work with in

resolving your case.

4. When you reach the end of the last line on the affidavit form, go on to a new page. If more

forms are needed than are supplied, you may make as many copies as needed to complete,

rewrite, or make corrections on your affidavit. Upon completion, turn your affidavit in to a

police officer at the University Police Department.

PLEASE DO NOT SIGN THE AFFIDAVIT FORM; IT MUST BE SIGNED IN THE

PRESENCE OF AN OFFICER.

5. It is imperative that your affidavit be delivered to UPD at your earliest convenience. Until your

affidavit is returned, your case cannot be investigated. If you have any questions, feel free to

contact the department investigator or any police sergeant at 940-397-4239.

CR#_____________________________________________

Return Date ______________________________________

Officer __________________________________________

MIDWESTERN STATE UNIVERSITY POLICE DEPARTMENT

WITNESS AFFIDAVIT

STATE OF TEXAS CASE NUMBER___________

COUNTY OF WICHITA OFFICER_________________

BEFORE ME, the undersigned, on this _______________day of _______________________, 20___, at

_______o’clock___. M., personally appeared_______________________________________, who after

being duly sworn, upon oath deposes and states:

My name is ______________________________________; My date of birth is_____________;

My address is__________________________________________, DL#_________________________.

____________________________________________________________________________________

I have read the forgoing statement and it is true and correct. I gave the same upon my solemn oath, fully

realizing that false swearing is a criminal offense under the laws of the State of Texas.

____________________________________________

Affiant

Witness:

SWORN TO AND SUBSCRIBED BEFORE ME, this________day of____________________,

20___, to certify which witness my hand and seal of office.

Page_____of _______. _________________________________________

Peace Officer ID#

STATEMENT CONTINUATION

Case # ___________

Page # ___ of ___

_____________________________________________________________

I swear that the above statement is true and correct.

________________________________________ Signature

Subscribed and sworn to before me the undersigned authority on this, the ____ day of

_______________________,

20 ____.

______________________________________

Peace Officer for the State of Texas