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2. 
3. Voluntary (Witness) Statement
   This form should be submitted when requested by a Loveland Police Officer. By completing this form you are providing this statement to the Loveland Police Department. You affirm the facts and statements included herein are true and correct to the best of my knowledge. You understand this document may be released under current public record laws.
5. First Name*
6. Last Name*
8. Email Address*
9. Phone Number*
11. Address
13. City
14. State
15. Zip Code
17. Police Officer Email*
    -- Select One --Brandon AsburyKyle BibelhausenMichael BoettgerAmy CampbellKevin CorbettJenna FisherMonica HammerScott HumphreyVicky JohnsonTina KernsKurt MagoteauxLarry MehnJesse MooreSteve MosterDakota ParksJacob SalamonAngela SmallwoodElliott SpraulJacob SteinkoenigMike SzpakMichael Wright
18. Report Number
20. Please Attach Files You Would like to Include
24. Statement*
26. Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
28. Electronic Signature*
Leave This Blank:


30. 1. Receive an email copy of this form.
31. Email address

    This field is not part of the form submission.

32. Submit Submit and Print

* indicates a required field