Voluntary Statement Form

SHERIFF'S OFFICE

DUNN COUNTY

615 Stokke Parkway - Menomonie, WI 54751 - (715)232-1348 - Dunn County Sheriff.com

Date and time *

I, the above named individual, did not grant permission to anyone to commit the above described crime(s) against me.

I acknowledge that all of the information provided in this form is true and accurate to the best of my knowledge *

* This section must be completed before you are able to submit the form. If you clicked submit and were not redirected to the Victim Information Sheet, please check that all the required boxes were filled out.

Work Phone

DUNN COUNTY SHERIFF’S OFFICE - VOLUNTARY STATEMENT FORM

Date of Birth: *

Incident Location/Address

Address *

Name: *

Cell Phone

Incident Date and time

Message: *

Incident Number:

Home Phone

Dunn County Sheriff's Office
615 Stokke Parkway - Menomonie, WI 54751
(715)232-1348 SHF@co.dunn.wi.us