Affidavit of Witness to an Incident

AFFIDAVIT OF WITNESS TO AN INCIDENT

I, ______, of ______, in the Province of Ontario, MAKE OATH AND SAY that:

1. On ______, at ______, I personally witnessed a ______.

2. What I saw, in my own words, is as follows: ______.

3. The people involved, so far as I know them, are: ______.

4. This account is true to the best of my knowledge and recollection.

5. I make this affidavit for the following purpose: ______.

SWORN / AFFIRMED before me at the ______________________ of ______________________, in the Province of Ontario, this ______ day of ______________, 20______.

_______________________________ _______________________________

A Commissioner for taking Affidavits Signature of Deponent