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RESTRICTED (when complete) Form MG11
WITNESS STATEMENT
(CJ Act 1967, s.9; MC Act 1980, ss.5A(3) (a) and 5B; MC Rules 1981, r.7O)
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Stat'.mentoL _ JvtvV\ f±nDE!3Jr.J . ·-ftj i ·- · ''M . - --
Occupat1on •.. _,. •• _.Q_(A_.Jr,. .. _ . Qf;/t.1Y2::.----
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Age if under 18 ..••.... ·--············· (If over18 111sert over 18 l
This statement (consisting of_............ _ ........ page(sl each signed by me) is true to the best of my knowledge
and belief and I make it knowing that, if it is tendered in evidence, I shall be liable to prosecution if t have wilfully
stated in it anything which I know to be false or do not believe to be true.
, .• _ Date ...... ~~t-~L~-~--
Signature ..... ___ ____ -__ C'~
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