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VILLAGE OF BELLVILLE .......................................................................BELLVILLE POLICE DEPARTMENT BP-39
NAME OF BUSINESS________________________________ TELEPHONE#_________________________ ADDRESS OF BUSINESS: __________________________________________________________________ HOURS OF OPERATION: __________________________________________________________________ EMERGENCY CONTACT: __________________________________________________________________ ADDRESS: ____________________________________________ TELEPHONE # ____________________ 2ND EMERGENCY CONTACT: _____________________________________________________________ ADDRESS: ____________________________________________ TELEPHONE # ____________________ OWNER OF BUSINESS: ____________________________________________________________________ ADDRESS: ____________________________________________ TELEPHONE # ____________________ OWNER OF BUILDING: ___________________________________________________________________ ADDRESS: ____________________________________________ TELEPHONE # ____________________ ALARM: __________ TYPE: _____________ ALARM COMPANY: ______________________________ ALARM COMPANY TELEPHONE # _________________________________________________________ HAZARDOUS MATERIALS: ________________________________________________________________ BUSINESS VEHICLES: ____________________________________________________________________ ADDITIONAL INFORMATION: _____________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ DATE CONTACTED: _______________ CONTACTED BY: _____________________________________ SIGNATURE OF PERSON CONTACTED: _____________________________________________________ |