Example of a Recommended Format for a Written Statement

By Robert A. Corry
Director, Fire Investigation Specialist
American Re-Insurance

4/18/99 7:15AM

Statement of Howard Smith, 5 Maple Place, Anytown, TX DOB 4/7/62; SSN 583456468, Tel# (787) 555-2323 (H)/ (787) 555-7995 (W). Next of kin: Jane Smith (wife), 5 Maple Place, Anytown, TX Tel# (787) 555-2323 (H). Employed: Handyman Lumber, 57 Main Street, Anytown, TX - Boss: Kevin Kelman Tel# 787-555-0129. Statement taken by Jones/Regan.

HS: I live with my wife Jane at 5 Maple Place. I left my house this morning for my usual morning jog at 5:30AM according to my kitchen clock. I went from Maple to Dunbar for about a mile then turned onto Windy Street right around 6AM according to my wristwatch. When I ran past 173 Windy Street I saw flickering light behind the picture window in the front of the house. I also saw that black smoke was coming out the front door. I realized that there was a fire. I went to the next house and knocked on the front door & asked the woman to call 911. She said, "the Quincys might be inside the house since their car was in the driveway."

I ran to the Quincys' back door behind the building and tried to open it. The door was definitely locked. I hit it with my shoulder and broke the jam so the door flew open. I tried to crawl in on my hands and knees yelling for the Quincys to answer. I could hear only crackling. The smoke was heavy and I couldn't see more than a few feet and had difficulty breathing. I backed out the same door I entered & saw the neighbor I had spoken with on the front lawn. She helped me get away from the house. I could barely breath & may have briefly passed out. We waited on the front lawn for the fire and police to arrive. HS

/s/ Howard Smith
4/18/99 10:15 AM

Reprinted with permission from the author.