Witness Statement Rear-end Collision (Formal)

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IN THE SUPERIOR COURT OF THE STATE OF___________________________
IN AND FOR THE COUNTY OF________________________________________
Plaintiff )  
Defendant )  

I, I.M. WITNESS, make this statement of my own free will and I hereby certify under the laws of perjury of the State of ____________________ that the facts presented herein are true and accurate, to the best of my knowledge and memory. My address is: ____________________________________________________________________________ I am over the age of majority and competent to testify. I am knowledgeable of the matters stated herein, which are based upon my personal observations.

I was proceeding east-bound on Jackson Avenue, at the intersection of Sixth Street in YOUR CITY, DATE ___________ TIME _________. At that time and place, there were no adverse road or driving conditions. The roadway was dry. The roadway is two lanes in each direction, with a turn lane. I was coming to a stop on the inside lane; the vehicle on the outside lane continued on through the yellow light. The stoplight was changing to red so I came to a stop. I looked in my rearview mirror and noticed that Mr. Plaintiff was slowing to a stop behind me. I looked ahead again, and I next heard a tremendous crash and screech. I looked up to see Mr. Plaintiff's car had been slammed forward, almost striking my vehicle. I called for the police on my cellular phone and then exited my vehicle. Both Mr. Plaintiff and Mr. Defendant had exited their vehicles. I heard Mr. Defendant apologize to Mr. Plaintiff. He stated that he was sorry, but he just didn't see Mr. Plaintiff slowing down.

I observed that Mr. Plaintiff's vehicle, although not dramatically damaged, had been driven forward about six feet. I observed a pile of dirt or debris and skid marks about six feet to the rear of Mr. Plaintiff's vehicle. I also noticed that although Mr. Plaintiff's vehicle was not damaged, Mr. Defendant's vehicle had significant damage to the bumper and hood, and the radiator was pushed back.

Neither party appeared to be injured although both said they were a bit shaken up. I stayed for the police and gave my report to Officer Dudley. Then I departed the scene. I have never met Mr. Plaintiff or Mr. Defendant before, and I have no interest in the outcome of any dispute or action regarding this claim.

Signed by: