Law Firm Incident Affidavit

STATE OF [State]

COUNTY OF [County]

I, [Affiant Name], being duly sworn, depose and state:

Background Information

Residence:

Occupation:

I am over the age of eighteen years and have direct knowledge relevant to the incident described below. I am not a party to the case but an observer of the incident.

Description of the Incident

On the day in question, at approximately [Time], I was located at [Location of the Incident].

I observed the following:

A vehicle was traveling at what appeared to be a speed exceeding the posted limit. The vehicle collided with a pedestrian crossing the intersection at [Specific Intersection].
The pedestrian, who had the right of way as indicated by the pedestrian crossing light, was struck on their right side and fell to the ground.
Immediately following the impact, the driver of the vehicle stopped, exited the car, and approached the pedestrian. Several bystanders also approached to assist.
Emergency services were called at [Time] and arrived at the scene approximately [Number] minutes later.

Statement of Truth

I certify that the facts stated herein are true and correct to the best of my knowledge and belief. I understand that providing a false statement under oath could result in penalties under the law.

Further Affiant Sayeth Not

I have provided all known information regarding the incident as witnessed and have no further details to add at this time.

Subscribed and sworn to before me this day of , .

Notarized by:

[Name of Notary Public]

[Notary Public, State of [State]]

[My commission expires: [Date]]

Seal:

[Notary Seal]