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r ALL INFORMATION CONTAINED HEREIN IS UNCLASSIFIED DATE 12-15-2006 BY 60324 uc baw/rs/lag CONSENT TO INTERVIEW WITH A POLYGRAPH PLACE i ica eT eee foe. DATE Boa TIME ff Hor. Before we begin an examination by means of the polygraph in connection with Ectyé ria fart ‘ I OOO you must understand your rights. YOUR RIGHTS Your appearance hear is voluntary, and you have the right to leave at any time. You have the right to refuse to take the polygraph test. If you agree to take the polygraph test, you have the right to stop the test at any time. : If you agree to take the polygraph test, you have the right to refuse to answer any individual questions. WAIVER AND CONSENT I have read this statement of my rights, and I understand what my rights are. I voluntarily agree to be examined by means of the polygraph during this interview. I understand and Know what I am doing. No threats or promises have been used against me to obtain my consent to the use of the polygraph. I understand that the examination room (@@es) (dces not) contain an observation device, and that the examination (4) (will not) be monitored or recorded. 7 roy “ ty ; SIGNED (2xaminee) ee (Examiner) b6 b 7C