You have the right to remain silent.
You have the right to consult a lawyer before answering any questions and to have him with you during questioning.
If you cannot afford to hire a lawyer of your choice, one will be appointed for you before questioning, if you so desire.
If you agree to answer our questions now, you still have the right to stop answering at any time. You may also stop answering at any time until you consult a lawyer.
You may use the telephone to contact a lawyer, or we will deliver a message to him, and you have the right to consult with him in private before questioning.
Anything you say of an incriminating nature may be used against you in a court of law.
I have read this statement of my rights and understand what my rights are. I am willing to answer questions and make a statement without a lawyer present. I do not want to talk to a lawyer before questioning. No promises or threats have been made to me and no pressure or force of any kind has been used against me. I understand what I am signing and I am both mentally and physically well. Further, I know of no mental or physical ailment which might be impaired by questioning.
Signed ________________________ Date ______________ Time_____________
TO BE FILLED IN BY INVESTIGATOR