SAPD Statement of Fact

This app is designed to work offline and locally on the device. It does not send data to a server. Save As File exports a real draft file for local storage on desktop or iPhone, while the app also keeps a local backup draft in the browser. To send a completed copy of this form, click Print / Save PDF to email a PDF copy to yourself or forward it to another officer.

Person Completing Statement

Date Statement Taken

Personally Appeared

Full Legal Name

Date of Birth

Enter month, day, and year separately for easier iPhone entry.

Age

Home Address

Telephone Number

Work Telephone Number

Workplace / Employer

Type of Incident / Offense

Date of Incident

Time of Incident

STATE OF TEXAS COUNTY OF TOM GREEN

BEFORE ME, the undersigned authority, on this day personally appeared , who, being by me duly sworn, stated under oath that the facts contained in this Statement of Fact are true and correct.

Case Number: Date Statement Taken:

Affiant Name:

Date of Birth: Age:

Home Address:

Telephone:

Employer:

Work Telephone:

Incident Type:

Incident Date/Time:

Statement

Tap Open full-screen editor for a larger dictation and editing view on iPhone. The statement area expands automatically as more text is added.

Statement

Mandatory: this box must be checked before Print / Save PDF or Save As File can be used.

By checking this box, you certify that your statement is true and correct, and you wish to lock your statement so no further changes or edits can be made.

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Review and Sign

Sign directly with a finger in the signature area. The signature stays only in this local app until the user chooses to export, print, or share it.

Date Signed

Time Signed

Subscribed and Sworn Before Me On This Date

Texas Peace Officer / Notary (Print Name / Signature / PIN)

Case Number / Internal Tracking

Person Making Statement Signature

Signature of Person Making Statement

Person Making Statement Signature

Officer Signature

Person Making Statement:

Case Number:

Date Signed:

Time Signed:

Subscribed and Sworn:

Officer / Notary:

Officer Signature - use a finger or stylus. Tap Clear Officer Signature to reset only the officer signature.

SAN ANGELO POLICE DEPARTMENT

STATEMENT OF FACT

Statement

Review and Sign