STATE OF ________________________
COUNTY OF ________________________ CERTIFICATE of WITNESS TO PROCEEDINGS
I, the undersigned witness, appeared as stated and I do hereby
certify that the below statements are true:
I, as Witness to Proceedings, and a Lawful Man or Woman over the
age of majority, and having firsthand knowledge of the facts herein, hereby
timely state that I witnessed on the below date the following behaviors and
activities in the room and location, and related to the Public Officer or Judge
in the case as listed and numbered below. I do hereby certify the fact, truth,
accuracy, and material completeness of my statements to the best of my
knowledge and belief. Further, I have no intent of improper purpose
such as to harass, cause unnecessary delay, or increase litigation cost:
Name of
Case__________________________________________________ Case # ______________________
Date of event:
________________ Room: _______________________________
Address/Location:
_______________________________________________________________________
Presiding Officer,
Magistrate, or Judge: ____________________________________
Behaviors and
Activities Witnessed:
Wherefore, I do certify that I have made truthful, honest and
accurate statements above, to the best of my knowledge and belief.
_______________________________________ Date:__________________
Signature of Witness to Proceedings
_______________________________________
(print name)
_______________________________________
Witness to Signature
_______________________________________
(print
name)