Voluntary Statement Form

Maries County Sheriff's Office
211 4th Street ~ P.O. Box 23, Vienna, Missouri 65582
Office: 573-422-3381 Fax: 573-422-3100

Maries County Sheriff badge.

[{"type":"paragraph","subtype":"p","label":"<div class=\"clear\"></div>","className":"d-block"},{"type":"text","required":true,"label":"NAME: ","name":"NAME-","className":"col-md-6","subtype":"text"},{"type":"text","required":true,"label":"DATE OF BIRTH:","name":"DATE-OF-BIRTH","className":"col-md-6","subtype":"text"},{"type":"text","required":true,"label":"SOCIAL SECURITY NUMBER:","name":"SOCIAL-SECURITY-NUMBER","className":"col-md-6","subtype":"text"},{"type":"text","subtype":"tel","required":true,"label":"PHONE NUMBER: ","name":"PHONE-NUMBER-","className":"col-md-6"},{"type":"text","required":true,"label":"MAILING / PHYSICAL ADDRESS:","name":"MAILING--PHYSICAL-ADDRESS","className":"d-block","subtype":"text"},{"type":"paragraph","subtype":"p","label":"<hr>","className":"d-block"},{"type":"paragraph","subtype":"p","label":"<p class=\"MsoNormal\" style=\"text-align:justify\"><i><span style=\"font-size:9.0pt\">I, _________________________, know I have the right to remain silent, I have a right to an attorney, I have a right to have my attorney present while being questioned, anything I say can and will be used against me in a court of law, and I know that if I cannot afford an attorney, one will be provided for me before any questioning, if I wish. I understand and waive these rights and freely make this statement. __________________________________, has explained that this statement must be given on my own free will and I know that the Deputy cannot make me any promises. I swear and affirm that the below stated facts are true and correct to the best of my knowledge and belief. <o:p></o:p></span></i></p>","className":"d-block"},{"type":"paragraph","subtype":"p","label":"<div class=\"clear\"></div>","className":"d-block"},{"type":"textarea","label":"STATEMENT:","name":"STATEMENT","subtype":"textarea","rows":47,"className":"d-block"},{"type":"paragraph","subtype":"p","label":"<hr>","className":"d-block"},{"type":"date","required":true,"label":"Date Field","name":"Date-Field","className":"col-md-6"},{"type":"text","label":"SIGNATURE","placeholder":"BY TYPING YOUR NAME, YOU ARE SIGNING THIS FORM","name":"SIGNATURE","className":"col-md-6","subtype":"text"}]