RESTRICTED (when completed)
MG 11 (T)
WITNESS STATEMENT
(CJ Act 1967, s.9; MC Act 1980, ss.5A(3)(a) and 5B; MC Rules 1981, r.70)
Statement of
John JONES ..............................................
Age if under 18
Over 18 .............
(if over 18 insert ‘over 18’)
Occupation:
Self Employed ..............................
This statement (consisting of: .... 3 ..... pages each signed by me) is true to the best of my knowledge and belief and I
make it knowing that, if it is tendered in evidence, I shall be liable to prosecution if I have wilfully stated anything in it
which I know to be false, or do not believe to be true.
John Jones
Signature:
Date:
26/05/1 .................................
This is my account of when I was attacked in my house and had some money stolen.
I will be referring to Paul Harris in my statement. He had been my business partner until last
month. The company we owned together was Harris Leathers a leather coat and shoe retail
outlet. The premises we joint owned were located at 24 High Street, Sandford. We were
partners for 12 years and we sold the business and went our separate ways. I now run a ladies
clothing shop on my own.
As a result of this incident I will be referring to my home address where I was assaulted which
is 17 Tower Court Apartments, Woodford Street, Sandford. It is a two bedroom ground and
first floor apartment. There is a front entrance door to the apartment from the street with a
parking space outside the front door. On entering the apartment there are stairs to the
bedrooms and bathroom immediately inside the door. At the foot of the stairs is a small
enclosed hallway and to the right of the stairs is a door leading to the through lounge and open
plan kitchen at the back.
On Sunday the 26th of MAY 2013 at 8.30 pm I was in the lounge watching the television. I
remember the time because the news had just finished. I heard a knock at the front door. I
turned the television off and went to the door. As I opened the door I saw Paul standing at the
door. It was dark outside but I could clearly see him as the hall light was on and he was stood
only about 2 feet in front of me. He walked into the hallway and stood next to the entrance of
the lounge.
Signature:
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2004/05(1): MG 11(T)
Signature witnessed by:
..................................................................
RESTRICTED (when completed)
Continuation of Statement of
Page 2 of 3
John JONES ...........................................................................................................
He smelt of drink and was swaying on his feet. He shouted at me,” I’ve come for the money
you owe you bastard”. I said “ Piss off ”. He stepped forward and brought his head to mine and
head-butted me on the nose. I felt dazed and staggered back against the door. My nose really
hurt and started to bleed. I could feel the blood coming out and I put my right hand to my nose
and pulled it away with blood on the tips of my fingers.
Paul then went into the lounge. I moved to the door of the lounge and stood under the frame of
the door. I saw him look around and pick up my wallet from a small coffee table. This was
beside the sofa and under the window. I had found a tissue in my trouser pocket and held it
against my nose to stem the flow of blood. I moved into the lounge to stop him.
He opened the wallet and removed some bank notes. He said, “Where’s the credit card” I said,
“ I don’t have any, just get out I’m going to call the police”. He then moved towards me and as
he walked past he grabbed me by the left shoulder, pulled me towards him and head-butted
me on the left side of my head. I fell to the floor in pain and was lapsing in and out of
consciousness. I saw him leave my house and get into a silver ford fiesta car, which he had
parked on my drive and I could see it through the lounge and front door. I know he owns this
car. He got into the drivers side and drove off spinning the wheels.
I managed to get my mobile phone from my trouser pocket and call the police. They arrived
within 20 minutes. I was taken in an ambulance to the local casualty hospital at 10.30 PM
where I was seen by Dr Smith.
The property Paul took from my wallet amounted to £150. This was in £10 notes.
I would describe Paul as a white man, 6’ 2” tall. He is very muscular in build and has shaved
his head hair. His face has a scar running across the bridge of his nose about three inches in
length. He has tattoos of letters on his knuckles, which spell ‘TRUE LOVE’. He was wearing at
the time he attacked me, blue training shoes, faded denim jeans, a white T shirt and a black
leather bomber jacket with mandarin collar. Paul lives at 1b Connaught Road, Sandford. I was
wearing a white t shirt and black trousers at the time I was assaulted and the t shirt had blood
on the front from my nose. I have received a broken nose and bruising to my face.
Signature:
2003(1)
...............................................
Signature witnessed by:
............................................................
RESTRICTED (when completed)
Continuation of Statement of
Page 3 of 3
John JONES ...........................................................................................................
John Jones
Signature:
2003(1)
...............................................
Signature witnessed by:
............................................................
MG11
Page 4 of 4
RESTRICTED – FOR POLICE AND PROSECUTION ONLY
(when completed)
Home address:
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Postcode:
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Home telephone number
........................................................Work telephone number
Mobile/pager number
........................................................Email address:
Preferred means of contact:
................................................................................................................................................................
Male / Female (delete as applicable)
Date and place of birth:
Former name:
Height:
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Dates of witness non-availability
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Ethnicity Code:
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Witness care
a)
Is the witness willing and likely to attend court? Yes / No. If ‘No’, include reason(s) on MG6. What can be done to ensure
attendance?
b)
Does the witness require ‘special measures’ as a vulnerable or intimidated witness? Yes / No. If ‘Yes’ submit MG2 with file.
c)
Does the witness have any specific care needs? Yes / No. If ‘Yes’ what are they? (Healthcare, childcare, transport, disability, language
difficulties, visually impaired, restricted mobility or other concerns?)
Witness Consent (for witness completion)
a)
The criminal justice process and Victim Personal Statement scheme (victims only) has
been explained to me
Yes
No
b)
I have been given the leaflet ‘Giving a witness statement to police — what happens next?’
Yes
No
c)
I consent to police having access to my medical records in relation to this matter:
Yes
No
N/A
d)
I consent to my medical record in relation to this matter being disclosed to the defence:
Yes
No
N/A
e)
I consent to the statement being disclosed for the purposes of civil proceedings e.g. child
care proceedings (if applicable)
Yes
No
N/A
f)
The information recorded above will be disclosed to the Witness Service so they can offer
help and support, unless you ask them not to. Tick this box to decline their services:
Signature of witness:
...............................................................................................................................................................................
Statement taken by (print name):
Station:
........................................................................................................................................................................................
Time and place statement taken:
Signature of witness:
2004/05(1): MG 11(T)
DS Joanne Belton .........................................................................................................................
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