Trespass Program Request

Trespass Program Request
You are the*

OwnerManagerOther
Authorizing person name*

First NameLast Name
Business/Property name*
Property address where trespass behavior is happening*

Street Address

Street Address Line 2

CityState

Zip Code
Phone Number*
Add your best contact to reach you.
Alternative Phone Number
Add your best contact to reach you.
E-mail Address*
example@example.com
Do you have video cameras on premise*

YesNo
Additional Contact

Please list the second required contact person’s name, full address, and phone number below:
Additional Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Phone Number*
Add your best contact to reach you.
E-mail Address*
example@example.com
I, {authorizingPerson}, as the {youAre} having lawful control of the {businesspropertyName157}, {propertyAddress:addr_line1}, {propertyAddress:addr_line2}, {propertyAddress:city}, {propertyAddress:state}, {propertyAddress:postal}, hereby authorize the Coral Springs Police Department and its officers to act as my agents in enforcing the provisions of Florida State Substantive Law 810.08 and 810.09. Officers of the Coral Springs Police Department are specifically authorized to make reasonable requests to leave any persons in or on the premises at a time or in a place wherein the premises are not open to the public. Furthermore, the officers are authorized to act as agents of the owner in arresting and prosecuting any persons who refuse a reasonable request to leave given by officers.

The undersigned agrees to cooperate fully in the prosecution of persons subsequently arrested for violations occurring on the premises and certifies that he/she is the owner or person having lawful control over the premises listed above.

The undersigned {youAre} agrees to notify the Coral Springs Police Department in writing when this authority is revoked, amended or there is any change in contact information. Failure to do so will allow the city the right to remove the trespass signs and the property from the program.
By typing and signing my name in the space below I certify this information to be true, accurate and complete.*

First NameLast Name
Should be Empty:

Trespass Program Request

Additional Contact