403.5E2 - Witness Disclosure Form

Name of witness:

 

Position of witness:

 

Date of testimony, interview:

 

Description of instance witnessed:

 

 

 

 

 

 

 

 

 

Any other information:

 

 

 

 

 

I agree that all of the information on this form is accurate and true to the best of my

knowledge.

 

Signature:                                                                               Date:

 

 

Approved: February 1996.
Reviewed:  April 2009, January 2011, January 2014, January 2017, May 2020