Authority to Arrest Trespassers Form (Alsip PD) How to Complete the Authority to Arrest Trespassers Form Type of Property Circle all descriptions that apply to the premises you wish to grant authorization for (e.g., circle “Common Areas” and “Parking Lot” if both descriptions pertain to your property). “Located at” Give the exact address of the property if it has one or directions to the premises (e.g., 1234 N. Main Street, Northeast corner of Main Street & 1st Street). Personal Information Please provide us with this information including a mailing address so we can inform you in the event of an arrest and provide court instructions. This information is for emergency contact and prosecution purposes only. When completed This form can be faxed to (708) 385-7750 to begin immediate enforcement on the named property. In order to ensure the legitimacy of the agreement a signed and notarized Authority to Arrest Trespassers form must be received by the Alsip Police Department via U.S. Mail within seven (7) days of receipt of the fax or the agreement will be terminated. The above requested items can be mailed to: Alsip Police Department 4500 W. 123rd Street Alsip, IL 60803 Providing false information may subject the signatory to appropriate criminal and/or civil penalties To if you would prefer to download this form for printing, please click here Alsip Police Department Authority To Arrest TrespassersThe undersigned owner, occupant or designated agent for the*(check all that apply) Vacant Structure Business Common Area(s) Parking Lot Other: Other - Describe Located at:* hereby authorizes the Alsip Police Department to arrest persons trespassing on the above premises pursuant to 720 ILCS 5/21-3 (Criminal Trespass to Real Property), and to sign complaints on behalf of the owner, occupant or designated agent. A person commits Criminal Trespass to Real Property by: 1) knowingly and without lawful authority entering upon the land of another after receiving notice from the owner, occupant, or an agent thereof that such entry is forbidden, or 2) remaining upon the land of another after receiving notice from the owner, occupant or an agent thereof to depart. This authority applies 24 hours a day. The under signed agrees to cooperate fully in the prosecution of persons subsequently arrested for trespassing violations occurring on the premises. This form is valid from the date of signature until the Alsip Police Department receives written notice to the contrary. The Alsip Police Department must be notified of any change in ownership as soon as possible.Signed and sworn to or affirmed before me this*1st2nd3rd4th5th6th7th8th9th10th11th12th13th14th15th16th17th18th19th20th21st22nd23rd24th25th26th27th28th29th30th31stDay Of*JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember20*(enter last 2 digits of the current year)Please enter a number from 20 to 99.Owner, Resident or Designated AgentSignature*Title* Name* Business Name* Mailing Address* City* State* Zip* Primary Phone*24 Hour Contact Phone*Cell Phone
