This statement should precede any and all reports or
statements requested by your department concerning your actions, other officers'
actions or incidents in which anything contained in the report or statement can
be used against you or other officers:
On_________ (date/time) at ________________ (place), I was
ordered to give this statement (report) by ____________________ (name/rank). I
give this Statement (report) at his/her order as a condition of employment. I
understand that I may face disciplinary action for disobeying this order so I
have no alternative but to abide by the order.
It is my belief and understanding that the Department
requires this statement (report) solely and exclusively for internal purposes
and will not release it to any other person or agency. It is my further belief
that this statement (report) will not and cannot be used against me in any
criminal proceedings.
For any and all other purposes, I hereby reserve my rights as
provided by the United States Constitution and any other rights prescribed by
law. Further, I rely specifically upon the protection afforded me under Garrity
Vs. New Jersey
385 U.S. 439 (1967).
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