---
title: "Truancy Control Project"
type: "pdf"
year: "1999"
canonical: "/projects/1104"
---

# Juvenile Enforcement Team 

# Table of Contents

- [Juvenile Enforcement Team](#juvenile-enforcement-team)
  - [Herman Goldstein Award](#herman-goldstein-award)
  - [Excellence in Problem Solving](#excellence-in-problem-solving)
  - [Executive Summary](#executive-summary)
  - [Shane Lynn, Scott Barnes  Mid-City Division of the San Diego Police Department](#shane-lynn-scott-barnes-mid-city-division-of-the-san-diego-police-department)
- [Juvenile Enforcement Team:](#juvenile-enforcement-team)
  - [Truancy Abatement Project](#truancy-abatement-project)
  - [Scanning: How is Truancy a Problem](#scanning-how-is-truancy-a-problem)
  - [Drug dealing as a result of truancy?](#drug-dealing-as-a-result-of-truancy)
- [Analysis: Does Truancy Effect Crime In Mid-City Division](#analysis-does-truancy-effect-crime-in-mid-city-division)
  - [Research](#research)
- [Crime Analysis:](#crime-analysis)
- [Offender Interviews:](#offender-interviews)
  - [Truant Activities](#truant-activities)
  - [Truants as Victims](#truants-as-victims)
- [Reasons for Skipping](#reasons-for-skipping)
  - [Key Factors Discovered:](#key-factors-discovered)
- [Problem Re-Statement:](#problem-re-statement)
  - [Response: Filling The Void](#response-filling-the-void)
  - [Short Term Goal:](#short-term-goal)
  - [Long Term Goal:](#long-term-goal)
- [Goal One: Build Relationships with school officials:](#goal-one-build-relationships-with-school-officials)
  - [Goal\# 2:Each child got a personal assessment](#goal-2each-child-got-a-personal-assessment)
- [Goal Three: Identify the primary barriers to each child's attendance](#goal-three-identify-the-primary-barriers-to-each-childs-attendance)
- [Long Term Goal Number One: Separate the Hard Core truants and hold them to strict accountability:](#long-term-goal-number-one-separate-the-hard-core-truants-and-hold-them-to-strict-accountability)
- [Long Term Goal Number Two: Create a process and new law to hold students accountability.](#long-term-goal-number-two-create-a-process-and-new-law-to-hold-students-accountability)
  - [Long Term Goal Number Three: Create a system of mentoring students who need positive influence.](#long-term-goal-number-three-create-a-system-of-mentoring-students-who-need-positive-influence)
  - [Assessment: The Effect of Social Control on Truant Behavior](#assessment-the-effect-of-social-control-on-truant-behavior)
- [1. Baseline Crime Information:](#1-baseline-crime-information)
  - [2. Truancy Rates of Chronic Students:](#2-truancy-rates-of-chronic-students)
- [3. Impact on Individual Students:](#3-impact-on-individual-students)
- [RISK FACTORS](#risk-factors)
- [SAN DIEGO POLICE DEPARTMENT](#san-diego-police-department)
  - [$\qquad$ Date](#qquad-date)

## Herman Goldstein Award

$99-57(\mathbf{F})$

## Excellence in Problem Solving

## Executive Summary

## Shane Lynn, Scott Barnes  Mid-City Division of the San Diego Police Department

Daily, Shane Lynn sat in the classroom of Mira Mesa High School listening to kids openly discuss ditching class to buy, sell and use drugs. Lynn participated in the hooliganism by cutting class to buy drugs. The only difference, Lynn was an undercover San Diego Police officer documenting drug sales. After his assignment was over, Lynn and his partner Scott Barnes discussed the problems Lynn saw in the schools. In their opinion many of the problems centered around truancy.

To verify the severity of the problem Barnes and Lynn interviewed numerous stakeholders including the principals, counselors, school attendance officers, community based organizations and criminal justice system components. Each person described their involvement and verified the severity of the problem. Many went on to say the problem was grossly under documented because funding was tied to attendance records.

Barnes and Lynn began coiling current research, local data and survey information to narrow the scope of the problem. They determined that chronic truancy was the symptom, and a lack of social control among school aged children was the core. They began a process of verifying the severity of the problem by talking to school attendance officers, DARE officers and juvenile detectives. They noted that juvenile truancy sweeps netted an average 40 students per sweep. They discovered that in some schools, $10 \%$ of the student population was absent, many just loitering about in the neighborhoods without supervision or control.

They also learned through an offender survey that $73 \%$ of the kids interviewed admitted to committing crimes other than truancy, including robberies ( $27 \%$ ), purchasing drugs ( $33 \%$ ) and fighting (53\%). Eighty one percent ( $81 \%$ ) described themselves as having been victims of crime. Most, $53 \%$, skipped with friends, although all ofthe survey respondents were arrested with friends. Sixty percent of the students said tighter controls, including juvenile hall, would encourage them to attend school.

Motivation for skipping ranged from being too far behind to disliking teachers. None admitted to skipping out of fear. The most frequent times for skipping school were beginning of the day, lunch time or the last period. They usually loiter close by, however sometimes frequent the homes of older friends.

Armed with this information, Officers Barnes and Lynn visited each school and obtained a list of the most chronic students. They took ten students from each of the six area schools, did a personal evaluation and gave each one special attention - trying to solve personal barriers to attendance. Those just deciding not to go were told of severe consequences, including imprisonment. Of those students who were chronically truant, $78 \%$ decided to attend school. Some decided not to and they were either incarcerated for a variety of charges or dropped from the school records. The average truancy rates fell from the students missing $43 \%$ of the time, to less than an $11 \%$ absenteeism rate. The project has now been implemented throughout the area command with an eye toward Department wide implementation.

The project was eventually handed off to DARE of ícers who now carry the chronic students as open investigative cases to bring the idea of social control. They have been active for about three months and day time crime associated with truancy has dropped $28 \%$ overall in this area.

# Juvenile Enforcement Team: 

## Truancy Abatement Project

Concerns over juvenile crime have reached an all time high. Shane Lynn observed firsthand how juvenile crime is inseparably linked to truant behavior. As an undercover police officer buying narcotics from students at a local high school, Lynn realized truancy was not only rampant, but part of the problem. Most of the drug transactions occurred while he and the other students were truant. After the indictments were unsealed and suspects arrested, Lynn debriefed the operation with school officials and police management. One of the issues discussed was the need to deal with truancy. He went back to patrol and enlisted the help of his beat partner who came from a long line of public educators. Both officers agreed to study the problem of truancy:

## Scanning: How is Truancy a Problem

The problem tentatively identified was drug dealing as a result of truancy. The officers began a process of problem verification. They spoke to over

## Drug dealing as a result of truancy?

40 different educational, justice and social service providers who gave them additional information and offered assistance in resolving the problem. Each juvenile justice stakeholder verified the severity of the problem and some stated that it was much worse because schools are hesitant to document the problem when funding is tied to attendance. All of the providers pledged their support in the effort.

Many of the juvenile service providers felt concerned about the problems, but were not able to get directly involved because they felt overwhelmed. The primary providers, the School Attendance Review Board, Community Assessment Team, Welfare, Juvenile Probation, the Juvenile District

Attorney, School Administration and the Juvenile Courts saw the problem as significant, but felt overwhelmed and not able to provide consistent follow-up.

A key problem arose and was noted during these interviews. No one was in place to consistently follow-up on truant students. Those students felt no one would follow-up and therefore felt no anxiety over threats of expulsion.

No one was in place to consistently follow up on truant students. They felt no anxiety over threats of expulsion.

Preliminary research was conducted and officers discovered there was some research to indicate a high correlation between high school drop outs and crime. In fact, one study obtained off the Internet stated that $15 \%$ of the U.S. population dropped out of high school prior to graduation. $72 \%$ of the prison inmates are drop outs. Many of those drop outs cited falling too far behind because of truancy as the problem'. The average I.Q. of Texas inmates is $87 .{ }^{2}$

According to Richard Tweksbury, University of New Orleans, "There is a direct link between poor academic achievement and crime." Of Florida inmates who were given basic literacy tests

- $\quad 15 \%$ of American's drop out of school
- $\quad 72 \%$ of drop out's are in prison
- Many cite "falling behind"
- Drugs cited as reason for falling behind
upon admission, $72.3 \%$ of inmates scored the at $9^{\text {th }}$ grade level. Now they have a Mandatory Literacy Program.

[^0]
[^0]:    *Correctional Education Connections, Adult Basic Education, Page 1, www.io.com , .
    ${ }^{2} 1$ bid,page 2

The problem of truancy, and its resulting effect on crime control, is linked by suspect group, behavior patterns and time of day and school year.

# Analysis: Does Truancy Effect Crime In Mid-City Division 

The analysis of this problem was divided into three main areas. These areas were: research review of juvenile crime and social behaviors, crime analysis data including school truancy records, and offender interviews.

## Research

Various experts on the topic juvenile crime and delinquency describe the problem in specific terms. Seymour Fliegel: Center for Educational Innovation, "Make a fuss over minor infractions and you'll avoid the larger, more serious ones. Kids want to know the parameters and they want limits."

A recent Department of Education, Department of Justice study found some relevant information:

- $.51 \%$ of female students in a

University of Maryland study
"I've never seen a gang member who wasn't a truant first. "Kim Menninger, Deputy D.A.
tested positive for drugs.'
'Wish, Gray and Levine, 1996, Recent Drug Use in Female Detainees: Estimates, College Park Maryland, University of Maryland, Center for Substance Abuse Research

- $53 \%$ of male students in San Diego arrested for truancy tested positive for drugs. ${ }^{4}$
- $\quad 71 \%$ of 13 to 16 year-old's prosecuted for criminal violations had been truant.
- $44 \%$ of violent juvenile crime in San Diego occurs during school hours.
- A three week concentrated Van Nuys truancy sweep reduced shoplifting arrests $60 \%$.
- St Paul Mn. saw street crimes drop $60 \%$ when truancy was enforced.'

Elliot ${ }^{\text {C }}$ Curey) University of California, "The worst thing we do with juveniles is go between two extremes. We do nothing at all or put them away."

Social Learning Theory: Criminal behavior is learned in small intimate groups. Learning takes place based on frequency, duration, priority and intensity of the negative contact. ${ }^{6}$

Mid-City Hypothesis: When not in school students are exposed to those who can influence their behavior in a negative manner. While in school students are exposed to more normal attitudes and behaviors.

Test: Survey of truant students to determine criminality and influence.
Social Control Theory: All people have the potential to commit crime, but fear of jeopardizing social bonds will prevent them. The four aspects of social bonds are: attachment, commitment, belief and involvement.

Mid-City Hypothesis: Students are not monitored by parents or other positive adult supervision. Truant students are not involved in school or extra curricular activities.
'Drug Use among San Diego Arrestees, SANDAG infor, Special Issue, 1996
${ }^{\text {*}}$ Manual to Combat Truancy, U.S. Department of Education, July 1996,
${ }^{6}$ Reid, Sue Titus (1994) Crime and Criminology. Ft Worth Tx: Harcourt Brace Publishers

Test: Assessment of truant students to determine family unit and extra curricular activities. To follow up on the national research, Barnes and Lynn began individual interviews with students provided by the school. They found strong trends that seemed to verify the information they had learned.

- $\quad$ Gang behavior or influence was apparent with each children.
- Drugs were common (in the home or the child was using).
- Little to no family support or control
- $65 \%$ came from single family households
- $\quad$ Fathers frequently absent in all but one of the cases

Most did not fear current consequences for truancy

The officers learned that the truants had no social control and were being influenced by criminals and poor role models while skipping school.

The truants skipped because there was no one to check up on them. The system already in place was effective in as far as it went. The School Attendance Review Board was legislatively put in place to catch habitual truancy. It soon became overwhelmed and unable to cope with recalcitrant students who were determined to ditch class: Their primary focus became children of tender years in a credible effort to stop the problem before it got started. However, there were children in middle school and high school with 85 truancies that were not in the process. The process took six plus months to work and numerous legislated steps to ensure the child was given every chance possible to comply with law.

According to published statistics, the San Diego Unified School District has 130,000 students. Only 430 minors and 450 parents have been prosecuted under the Iegislation since its inception in San Diego County.' The latest statistics available show that 347 problem attendance children were identified and sent to SARB. Of those, 344 were sent a letter three (3) were sent a subpoena. And there are a variety of resources that impact the student's behavior. SARB refers the student to them for help. However, many students, especially in the middle and high schools either drop out, are dropped or are not followed up on because SARB is overwhelmed.

# Crime Analysis: 

Questions arose in the officer's minds whether truancy actually influences the crime rates in Mid-City Division. To solve this question they contacted Crime Analysis for information concerning juvenile crime, juvenile arrests and juvenile victimization. Some interesting facts were discovered.

- $60 \%$ of thefts in Mid-City where juveniles were the known suspects occurred during school hours.
- $43 \%$ of the burglaries in Mid-City where juveniles were the known suspects occurred during school hours.
- $29 \%$ of robberies in Mid-City where juveniles were the known suspects occurred
![img-0.jpeg](https://popdatasets.blob.core.windows.net/popdatasetmdimgs/99-57%28F%29/img-0.jpeg)
during school hours.
Law Enforcement Quarterly, Volume 27, No. 1, Spring 1998, Page 2

- $\quad$ Excluding child molestation, 59\% of juvenile victimization occurred during school hours.
- An additional 23\% occurred between 4:00 P.M. and 7:00 P.M. when they should be doing homework.
![img-1.jpeg](https://popdatasets.blob.core.windows.net/popdatasetmdimgs/99-57%28F%29/img-1.jpeg)


# Offender Interviews: 

To gather additional information officers began a survey of truant students. They decided not to inter view the children on their list because they believed the kids would not be forthright. The kids would say just about anything to get the officers off their back.

The result of the survey shed additional light on the problems faced by the kids.

## Truant Activities

- $\quad 73 \%$ of truant kids admitted committing other crimes while truant.
- $\quad 53 \%$ used drugs, an educational de-motivator.
- $\quad 33 \%$ vandalized property.
- . $33 \%$ stole from a store.
- $33 \%$ bought drugs.
- $27 \%$ committed robberies.
- $27 \%$ stole from a house.
- $27 \%$ had sex.


## Truants as Victims

- $87 \%$ of the sample had been victimized. (Not necessarily while truant)

- $53 \%$ skip with a friend (all contacted were with a friend at time of arrest)

Frequency

- $67 \%$ skip more than 6 times a month
- $73 \%$ attend only part of the school day
- $27 \%$ they commit crime often or always
$27 \%$ commit crime
often or always

Places to Go

- $53 \%$ hang in neighborhood
- $33 \%$ go to stores
- $14 \%$ stay on campus


# Reasons for Skipping 

- $33 \%$ too far behind
- $27 \%$ tired (possibly a result of drug usage)
- $27 \%$ bored
- $27 \%$ dislike teachers

The combination of the following facts lead officers to believe the problem was sightly different than they originally thought.

## Key Factors Discovered:

Each child has a personal reason why they skip school
Each child has strong influences sending them the wrong direction
There was a clear lack of direction in the child's life
Many of the truant students were committing crime while truant

Most students believed there was an answer and personal attention was important The current mechanisms were inadequate

# Problem Re-Statement: 

There is little or no social control over students who are expose to criminal influences while skipping and the current system of controls is incapable of exercising individual accountability or control.

## Response: Filling The Void

Officers Barnes and Lynn realized they needed to bring personal attention and social control to those who were at risk of criminality. As an experiment, they went to the schools in their command and asked for their 10 most truant students from each school. They were given a total of 65 kids. Based on their analysis the officers developed short and long term goals to guide their project:

## Short Term Goal:

1. Build a working relationship with school attendance officers and administrators.
2. Perform a personal assessment on those students who did not immediately comply with police contact.
3. Identify the primary barriers for each child's attendance.

## Long Term Goal:

1. Separate the "hard core" truants and hold them to strict accountability.
2. Create a process and new law to hold students accountable.
3. Create a system of mentoring students who need positive influence.

# Goal One: Build Relationships with school officials: 

Their short term goals were realized. The officers began by sitting down with the attendance officers at each school. Most were more than receptive and desired the help ofBames and Lynn. Corporately they established an "advanced notification system" where the schools called and left voice mail for Barnes and Lynn concerning who on the habitual truant list was absent. The officers would follow up on as many of those kids as possible.

## Goal\# 2:Each child got a personal assessment

After a short while the officers got a sense of who was the problem and who needed help. Those needing help received a personal house visit one hour prior to school starting. Those children were put on a short list of special attention.

The officers got written consent from parents, some of whom were frustrated, to roust the kid out of bed. Those parents not wanting. the police -around for a

Each child needed and got a personal assessment
variety of illegal reasons, decided to get rid of the officers by sending their kids to school. Ina couple of cases the parent's in-house criminal behavior was preventing the children from attending. Two relatives were arrested on serious felony charges and another was discovered to be a convicted sex offender living with children in violation of a court order.

Additionally, Barnes and Lynn learned many of the children wanted to go to school, but were not allowed because of medical conditions such as lice. Barnes and Lynn dealt with those individual problems first. Then they leveraged newly enacted California law that with held welfare monies from parents whose children where chronically truant. This motivated the parents to treat the medical condition and get the kids back in school.

There were a variety of reasons for the kids missing school. From cocaine addicted mothers who stayed out late prostituting themselves, to parolees on the run from the authorities and others who just could not get themselves out of bed to get the kids ready for school.

# Goal Three: Identify the primary barriers to each child's attendance 

Barnes and Lynn obtained an assessment tool to determine why the student was struggling with attendance. Using this tool they looked at each child, identified the reason and removed the barrier if possible. Those who were truly recalcitrant and choose not to go to school were singled out for enforcement.

For the rest officers worked with various community resources and family members to solve the individual problems. In one case the mother and her boyfriend were both parolee's at large and addicted to rock cocaine. They had abandoned the kids for fear of police intervention and were roaming the streets. The children avoided police contact out of fear and hid anytime they were near. The officers finally forced entry into the home under exigent circumstances and found the kids being supervised by a 12 years old and living in squalor. After some research the officers learned the legal

guardians lived in Utah and wanted the children to come live there. Using their own cellular phones they tracked down the mother and got permission to send the kids to the legal guardian grandmother. They networked with the NICE Guys Inc. who purchased one way airfare to Utah for each of the kids. When Barnes and Lynn told the kids the good news, they cried and got fully packed with in two minutes throwing some clothes in a back pack and grabbing their skateboards. The oldest son told the officers, "We love it at grandmothers. "We get food, new clothes, and we get to go to school."

# Long Term Goal Number One: Separate the Hard Core truants and hold them to strict accountability: 

When one attaches the results of the survey to the theory of social control, it becomes apparent part of the problem is a lack of accountability and control. To overcome this problem, officers were assigned individual students to monitor and follow-up on. These students were told they would be expedited through the system and contacted on a daily basis. Officers went to the students homes and classrooms daily to see if they were compliant. Those who were compliant for a period of one month were put into a monitoring status. Those not compliant were referred to SARB, the District Attorney or Probation depending on their status. There was limited success with these students. Those who were moved by "nagging" went to school and followed through with attendance. Those who were gang members or so far behind that it was hopeless, still refused to attend. The current Juvenile Justice system was unwilling to make this a top priority.

A new project has just begun to involve volunteers in teaching kids the basic fundamentals of learning, study and education. This topic will be discussed in greater detail under mentoring.

# Long Term Goal Number Two: Create a process and new law to hold students accountability. 

It was clear to officers that there was a legal gap between the chronic truancy state statute and the municipal ordinance of daytime loitering. The daytime loiters were cited to traffic court, while the chronic truants had to endure a long, ( 6 to 8 months) SARB process. Only three of the 344 students sent to SARB were eventually subpoenaed to court, while another 29 were placed on probation. A new law was written to address this gap and the bill is now being reviewed by the City Attorney.

One suggestion was to give the Principals authority to cite the students directly to the Court, but school officials choose not to allow this to take place, having concerns over liability and logistics.

## Long Term Goal Number Three: Create a system of mentoring students who need positive influence.

Mentoring projects abound in San Diego and all major cities. This project was designed with a specific ideal in mind. Tailored after a project in Washington D.C., and the subject of a book, The Triumphs of Joseph ${ }^{\text {® }}$ volunteer Bill Arnsparger a retired NFL football coach, began an organization to work with those children needing direction and assistance. Identified by officers as willing to improve but needing assistance, Arnsparger and team began mentoring the young men and leading them to maturity. It is too early to assess the outcome, but the results appear favorable.

## Assessment: The Effect of Social Control on Truant Behavior

While some assessment has begun, the project is still in the Analysis and Response stage. The law has yet to be passed and the impact measured; the mentoring program is in the formation stage and

measurements are yet to be installed; and the long term truancy measurements since it's transition to DARE officers has yet to be studied. However, the primary measurements for this project were broken into three areas:

1. Baseline juvenile crime by time of day information.
2. Truancy rates of chronic students.
3. Impact on individual students.

# 1. Baseline Crime Information: 

Juvenile crime was studied to determine if the overall crime rates were being affected by dealing with truancy. The Crime Analysis Section supplied static crime rates by age and time of day. Those statistics were compared to the same time frame the previous year. Overall, there was a 20\% reduction in crime with a $30.8 \%$ reduction in daytime crime in Mid-City, while a $6.2 \%$ average reduction in those same crimes city wide. It should be noted that the Juvenile Service Team increased their frequency of truant sweeps to every Thursdays, adding to the idea of social control and improving the effectiveness of the effort.
(See attached crime charts)

## 2. Truancy Rates of Chronic Students:

Prior to the implementation of social control through juvenile enforcement, the average student on the JET list was absent $43 \%$ of school days. After the JET officers took over the students were

absent $18 \%$ of school days, and if you remove the worst $10 \%$ of offenders who need court intervention the time absent rate drops to $11 \%$. This information is based on school attendance data: The greatest correlation between what worked and what did not was the level of communication and cooperation between school attendance personnel and officers. The most cooperative schools phoned the officers immediately to let them know of missing students who were on their list.

# 3. Impact on Individual Students: 

There is much allegorical evidence to suggest this program works well. School administrators such as Mike George, Dean of Students at Monroe Clark Mddle School said, "I wish I had a hundred of these officers. This program works." Several of the children contacted are not only going to school, but excelling academically. Others are at least in an environment where teachers can begin the process of education. A few, those needing the justice system, have been locked up or placed on probation.

Any inquires should be directed to:

John Madigan, Captain,
San Diego Police Department Mid-City Division,
4310 Landis Street,
San Diego California, 92105.

# RISK FACTORS 

INSTRUCTIONS:
COMPLETE THE MOST APPLICABLE BOX. IF YOUR SELECTION IS NOT ASSOLUTELY AFFIRMATIVE. USE AN ARROW POINTING IN THE DIRECTION YOU WOULD LEAN TO IF GIVEN ANOTHER CHOICE. SEE EXAMPLE TO RIGHT.
![img-2.jpeg](https://popdatasets.blob.core.windows.net/popdatasetmdimgs/99-57%28F%29/img-2.jpeg)

| OTHERISK FACTORS |  |  |  |  |  |  |  |  |  |  |  |  |  |
| :--: | :--: | :--: | :--: | :--: | :--: | :--: | :--: | :--: | :--: | :--: | :--: | :--: | :--: |
| OR CONCERNS: | CI ANI AL CRUELTY |  |  |  |  |  |  |  |  |  |  |  |  |
| (PLEASE CHECK ALL BOXES THAT MAY APPLY) | 0 BLADDER CONTROL. |  |  |  |  |  |  |  |  |  |  |  |  |
|  | 0 DAVIN-E LACK OF |  |  |  |  |  |  |  |  |  |  |  |  |
|  | 0 BLADDEN CONTROL. |  |  |  |  |  |  |  |  |  |  |  |  |
|  | 0 NIGHTIME LACK OF |  |  |  |  |  |  |  |  |  |  |  |  |
|  | 0 CHRONIC TARDINESS |  |  |  |  |  |  |  |  |  |  |  |  |
|  | 0 EMOTIONAL DISTRESS |  |  |  |  |  |  |  |  |  |  |  |  |
|  | 0 FIRE SETTING |  |  |  |  |  |  |  |  |  |  |  |  |

COMMENTS AND OBSERVATIONS:

# SAN DIEGO POLICE DEPARTMENT 

Consent to Search.
I, $\qquad$ the parent/or legal guardian of
authorize San Diego Police officers to assist me in getting my child to school. I authorize Officers Scott Barnes and Shane Lynn to enter my home between the hours of 7:00 am. and 2:00 p.m., if my child is absent/or truant from school without my prior permission. I fully understand my constitutional rights concerning not to have a search made of my premises without a search warrant and of my right to refuse consent to a search. I authorize the officers to enter my home to check on the welfare of my child and direct the child to attend school by any legal means.

I fully and voluntarily give my written permission without coercion, threats or promises of any kind.

Parent/or legal guardian signature

## $\qquad$ Date

Witness signature