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2. Attention!
   DO NOT RELY ON THIS SERVICE FOR ANY EMERGENCY COMMUNICATION WHATSOEVER TO LAW ENFORCEMENT. IN THE EVENT OF AN EMERGENCY, PLEASE DIAL 911
4. Location of Close Patrol*
   Block number and Street name, or intersection
6. Days of Concern*

   1. Sunday
   2. Monday
   3. Tuesday
   4. Wednesday

   1. Thursday
   2. Friday
   3. Saturday
7. Time frame for Close patrol*
   example: 10:30 pm-1:30 am
8. Does matter concern Truancy?
   -- Select One --YesNo
10. Description of reason for Close Patrol*
    *please be as detailed as possible i.e. suspect descriptions/actions and/or why you are requesting for a Close patrol of the area.
12. Contact Information
    You are not required to fill out the contact information. However in the event a criminal offense is discovered to have occurred and suspects are located your testimony may possibly help with a criminal investigation and/or possible prosecution of suspects.
14. First Name
15. Last Name
17. Address1
19. Address2
21. City
22. State
23. Zip
Leave This Blank:


25. 1. Receive an email copy of this form.
26. Email address

    This field is not part of the form submission.

27. Submit

* indicates a required field