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2. Date of Authorization (Authorization good for one year)*
   Date of Authorization (Authorization good for one year)
4. Property Name*
6. Property Address*
8. E-Mail Address of owner/lessee/owner's agent*
9. Work number of owner/lessee/owner's agent*
10. Mobile number of owner/lessee/owner's agent*
12. Type of Property*

    1. Residential
    2. Commercial
13. If Residential, number of Units

15. I am the owner/lessee/owner's agent/person in lawful possession of the above-referenced property. I request and authorize the Farmington Police Department to enter and enforce:

17. "X" next to each item you wish to authorize for enforcement

    1. Farmington City Code Sections 18-3-11 and/or 18-3-12
    2. Any traffic laws, fire zone laws and handicap parking laws

19. My property has either been posted in accordance with the Farmington City Code Section 18-3-13 with signs that the property is closed to the public traffic and no entry is allowed without the permission of the owner, lessee owner's agent, or person in lawful possession or;

    I have given authorization to the Farmington Police Department to advise persons under City Code to leave my property. I further authorize the Farmington Police Department, upon contacting persons committing any violation of Farmington City Codes 18-3-11 or 18-3-12, or arrest, cite, and/or inform them not to return for one (1) year to my property pursuant to Farmington City Code Sections 18-3-11 and 18-3-12. I or my agent will cooperate fully in the prosecution of anyone who is arrested or cited for a violation of any local or state law, including trespassing or vandalism. This request may be terminated at any time in writing by the property owner or the assigned representative. I understand enforcement is at the discretion of the Farmington Police Department and does not require any specific action to be taken.

21. Authorizing owner/lessee/owner's agent/person in lawful possession of property*
Leave This Blank:


23. 1. Receive an email copy of this form.
24. Email address

    This field is not part of the form submission.

25. Submit

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