Nursing Home Affidavit of Witness Statement
I, [Your Name], being of legal age, do hereby swear and affirm:
I am residing at [Your Address]. I am competent to testify to the matters contained herein.
I swear under oath that the information provided in this affidavit is true and correct to the best of my knowledge and belief.
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.
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.
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]
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