Notice: Pursuant to section 76-8-504.5, Utah Code Annotated, 1953 as amended, you are notified that statements you are about to make may be presented to a magistrate or judge in lieu of your sworn testimony at a preliminary examination. Any false statement you make and that you do not believe to be true may subject you to criminal punishment as a Class A Misdemeanor.

I do give this statement of my own free will. I understand that I have the right to remain silent, that anything I say can be used against me in the court of law, that I have the right to talk to an attorney, and to have him present when I make this statement, that if I cannot afford an attorney on will be appointed for me if I so desire. I understand that I have the right to stop answering questions at any time.

I fully understand the rights above I make the following statement.