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RICHLAND TOWNSHIP POLICE DEPARTMENT NOTIFICATION OF RIGHTS R.C.I. Number | 2742 Am, Lat fa Time VALEZA I, the undersigned : an LO Years of age, I realize that I am | being questioned about the crime or crimes of FAVS ISTVE VMOU tat -_ Li Sotdorty” L0Hf ET: JLB LOL tl Pe) F— And before answering any questions or making any statements, od A person who’. identified themselves as a RICHLAND . uly warned and ak advised me, and I know and understand that I have the following rights as READ TO ME BY THIS OFFICER. | 6 FERS SSS SSS RE SSR REESE SSSSSS SSE r————o pI CSSSSE5 1. :That I have the right t i i t and not make any statement. / No a . ce 2. That anything I say can i used against me in a court of” law (2 / No INITIALS ~ ee 3. That I can have a lawyer of my own choice to advi > any questioning. / No. - INITIALS 4 That if I cannot afford to hire a lawyer, J can request, and‘ recéiveé He appointment of a lawyer, by the PUBLIC DEFENDERS OFFICE, without. cost i charge to me, to be present with me and advise me before and duri questioning or statements I may make, . / No INITIALS - 5. That I can stop. making statements or answerin uegtions at any time™ choose. - / No INITIALS : . . 6. That no law enforcement officer can prompt ay in any atement or write it o nless I choose for them to do so. / No INITIAL WAIVER OF THESE RIGHTS IN ORDER TO SECURE A WAIVER OF THESE RIGHTS I MUST ASK THE FOLLOWING QUESTIONS AND RECORD YOUR RESPONSE. _ 7 1. DO YOU UNDERSTAND THESE VE JUST EXPLAINED TO YOU? (Hes) / vo INITIALS 2. WITH THESE RIGHTS IN MIND, ISH TO TALK TO ME NOW AN WER | QUESTIONS WITHOUT AN ATTORNEY? / NN | Witness Signatur Witness. _Date ]