Nursing Home Affidavit of Witness Statement
Nursing Home Affidavit of Witness Statement
I, [Your Name], being of legal age, do hereby swear and affirm:
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I am residing at [Your Address]. I am competent to testify to the matters contained herein.
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I swear under oath that the information provided in this affidavit is true and correct to the best of my knowledge and belief.
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On [Month Day, Year], I was present at [Your Company Name], located at [Your Company Address]. I observed an incident involving [Party A’s Name] and [Party B’s Name]. The incident occurred in the [Incident Location] at approximately [HH:MM AM/PM]. [Party A’s Name] appeared to be verbally aggressive towards [Party B’s Name]. [Party B’s Name] appeared to be visibly upset and frightened.
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I am providing this statement to document the incident I witnessed on [Month Day, Year] at [Your Company Name]. This affidavit may be used in any ensuing investigation or legal proceedings.
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The incident occurred during the afternoon shift. There were no other staff members present in the room at the time of the incident. I immediately reported the incident to the nursing home administrator.
I affirm the truthfulness of the information provided in this affidavit. I understand that making a false statement in this affidavit could subject me to penalties for perjury.
[Your Name]
Subscribed and sworn to before me this [Month Day, Year].
[Name of Notary Public]
Notary Public, State of [State Name]
My Commission Expires: [Month Day, Year]
