NATURE OF INVESTIGATION
PERSON MAKING STATEMENT
SOCIAL SEC. No. DOB SEX
HOME ADDRESS (St., City,,State, Zip code)
DRIVER'S LIC. NO. HOME PHONE
615 11th Street Tell City, IN 47586
EMPLOYMENT (occupation and location)
DATE/TIME STARTED WORK PHONE
Law Enforcement Officer-Hoosier National Forest
9/13/96 - 9:35 am 812-547-7051
LOCATION STATEMENT TAKEN
NAME OF OFFICER TAKING STATEMENT
On July 2, 1996 at approximately 10:3O pm while working at the Rainbow Famly Gathering north of Thomasvlle, Mo on the Mark Twain National Forest I had contact with a vehicle with three passengers in it. I was working at the West checkpoint and approached the vehicle on the passenger side. A white female, name unknown, asked me, 'Are we committing any violation?' I replied, 'No'. The female immediately proceeded to ask me what my name was and I obliged and even spelled it for her. She had a pen and paper on her lap prepared to write down things. I asked her name and she would not reply.
The other individuals in the vehicle consisted of a white male driving and a black male in the back seat of the vehicle. The license plate on the vehicle was DWC 310. 1 do not recall the state.I have read the foregoing statement consisting of 1 pages. I fully understand this statement and declare that the foregoing is true, accurate and complete to the best of my knowledge. I have signed or initialed each and every page and have been given an opportunity to make any corrections or additions.
I made this statement freely and voluntarily, without threats or rewards, or promises of reward having been made to me in return for it.
SIGNATURE OF PERSON MAKING STATEMENT
WITNESS' SIGNATURE(If Applicable)