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Ame: DOB: / / Case # Address: Home Phone: Alternate Phone: I, , declare the following statement was made freely and voluntarily without threats or promises of any kind. I, , declare under the penalty of perjury of the laws of the State of Washington that the above statement is true and correct. Place: Signature: Date: Officer Signature: VOLUNTARY STATEMENT (CONTINUED) Page of I, , declare the following statement was made freely and voluntarily without threats or promises of any kin.

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