HomeMy WebLinkAbout2019 01 22 Public Hearings 501 - New Cases - WS-2WINTER SPRINGS P01ACE DEPARTMENT
300 N. MOSS RD.
WINTE"R SPRLORI
SPRINGS, 1"DA 32708
PROSECUTION RELEASE
do hereby release the Winter
Springs Police Depailment from any and all further investigations of this case. I do not wish to
proceed with any further prosecutions with reference to this case.
Pers�o-i-i--A�uthoriz'i igg Release o1` Prosecution
Subscribed and s orn bel'ore me this
Day of,, 20 1
1.,"E.O. (F.S.S. 1 7.10)
WSPD 4' 44 01/08
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Name M I - 114.4tj_ W&110 .44Ay jMgA)1e_0 D.O.B. -6q / ox"?
Address t f b S
City L��wzflL State FL__ —Zip Code 3 a 70
Home Phone Cell Phone j;2tjj 7( Work Phone (56L-2) L
3 9 L
E -Mail Address Other Phone Contact
Status of Involvement: L.E.O. Victim Witness Other
If you are the Victim in this case, please indicate your request or refusal to pursue charges against a suspect.
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Filling out a false affidavit voluntarily made is a crime under Florida State Statutes 837.02, 775.082, 775.083.
10o you swea,7 affirm that th
,,-4bove statement(s) is / are true and correct? Yes or No needs to be written
Data / ZJ (2-/
4ZDate Lz1_4z1_t_r
I Sworn I o and S,6 d Before Arte
Law Enforcement Officer Conducting Official Investigation
WSPD # 94A 07/07 Page __L of
IL
Filling out a false affidavit voluntarily made is a crime under Florida State Statutes 837.02, 775.082, 775.083.
10o you swea,7 affirm that th
,,-4bove statement(s) is / are true and correct? Yes or No needs to be written
Data / ZJ (2-/
4ZDate Lz1_4z1_t_r
I Sworn I o and S,6 d Before Arte
Law Enforcement Officer Conducting Official Investigation
WSPD # 94A 07/07 Page __L of