Voluntary Statement Form
Written by Sheriff Jerry Allen
Instructions for filling out the Voluntary Statement Form:
- DO NOT enter any information into the top box.
- Completely fill in the second box.
- It important to have a VALID address in order to send documents, should the incident go forward to prosecution.
- It is also important to have a VALID telephone number to conduct any follow up that may be needed.
- Write a detailed description of the incident you are reporting-include the Who, What, When, Why, Where and How, if possible.
- Sign the form on the signature line.
- If additional room is needed, you can use page 2 or use regular lined paper. Be sure to number all additional forms and sign them.
- Mail the form to-Pershing County Sheriff’s Office, ATTN-Under Sheriff Thom Bjerke, P.O. Box 147 Lovelock, NV 89419
- Or Fax it to 775-273-5052 with attention to Under Sheriff Thom Bjerke.
- When the form arrives, it will be disseminated to a Deputy for investigation.
- Please allow a reasonable amount of time for your incident to be disseminated.
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