Affidavit Page - Blood/Medical Issues
Affidavit for blood and or medical
treatment in which you were
affected or suffered loss due to
beliefs of Jehovah's Witnesses
* Required Field
Your name:
*
Email:
*
Current
Address:
JW or
XJW:
Date
Submitted:
Please in a factual way tell what happened.
Use times, dates, and places for accuracy.
If you have additional information or
documentation please advise at the end of
your statement and we will contact you on
how to send your material. Your information
will be used to protect children and help
those in crisis :
*
INSTRUCTIONS

1. Submit your information on the following form.
2. We will place your information on a Affidavit and convert it to PDF format.*
3. We will send the PDF back to you in an email.
4. Sign completed affidavit and have it notarized.
5. Send completed Affidavit to PO Box 311, Calvert City, KY 42029

*Information maybe edited for spelling and content.