MIRANDA RIGHTS WAIVER - Elsevier
MIRANDA RIGHTS WAIVER
Date/Time/Location: _________________________________________________________
I, ____________________________________
(print full name)
have been advised by ___________________________________________, of the
(rank, name, badge number)
_____________________________________________ that I am suspected of:
(agency)
A. ________________________________________
B. ________________________________________
C. ________________________________________
I have also been advised that:
1. I have the right to remain silent and make no statement at all;
2. Any statement I do make can be used against me in a court of law or other judicial or
administrative proceeding;
3. I have the right to consult with a lawyer prior to any questioning; this lawyer may be a civilian
lawyer retained by me at no cost to the United States, or if I cannot afford a lawyer, one will be
appointed to represent me at no cost to me.
4. I have the right to have my retained or appointed lawyer present during this interview; and,
5. I may terminate this interview at any time, for any reason.
I understand my rights as related to me and set forth above. With that understanding, I have decided that I
do not desire to remain silent, consult with a retained or appointed lawyer, or have a lawyer present at this
time. I make this decision freely and voluntarily. No threats or promises have been made to me.
Signature: _______________________________________________
Date and Time: ________________________________
Witness: _________________________________________________
Date and Time: _________________________________
At this time, I _____________________________ desire to make the following voluntary statement. This
statement is made with an understanding of my rights as set forth above. It is made with no threats or
promises having been extended to me.
................
................
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