HomeMy WebLinkAboutTrespass Form TIGARD POLICE DEPARTMENT
TRESPASS FORM
1, ,as(owner)(manager)(leasee) of
(name)
,located at
(business name or type of property)
,Tigard, Oregon,97223,
(street address and/or other description of the property)
Hereby authorize the Tigard Police Department(TPD)by and through its Chief of Police to appoint
uniformed members of the TPD to act as my agent(s)for the purpose of enforcing Oregon's criminal
trespass laws(ORS 164.205 to ORS 164.270)on the Property listed above.
Check if applicable. The below listed person is hereby trespassed from the above listed property for
period of years. Associated TPD case number
(Name,address,phone#of person being trespassed)
All appointed TPD Officers will be considered"Persons in Charge"as defined in Oregon Revised Statute
164.205 when taking action on the property. Individuals in or upon the Property without authorization
may be arrested for Criminal Trespass II, or ejected from the Property and thereafter excluded from
entering or remaining in or upon the Property indefinitely.
I(or a person whom I have appointed)will respond to any and all subpoenas and subsequent Court
appearances as required to prosecute any individuals arrested by officers of the Tigard Police Department
resulting from this authorization.
I or my appointee, , can be contacted by mail at
(name)
,and by phone at
(mailing address)
(telephone)
This permission is given voluntarily and hereby effective from this day forward for years or until
revoked in writing. I hereby release the City of Tigard, its employees,officers, agents and insurers from
any and all liability, claims, and causes of action arising as a result of,or related to my consent to this
authorization.
(signature) (date)
White Copy—Tigard PD Case File Pink Copy—Property Owner Yellow Copy—Trespassed Person