Police Department - Responsible Person Form

[Pages:1]City of North Las Vegas

POLICE DEPARTMENT ? RESPONSIBLE PERSON LISTING

2266 Civic Center Drive, North Las Vegas, NV, 89030

In order to better serve you, the North Las Vegas Police Department keeps a listing of responsible persons to contact in the event of a crime or emergency occurring involving your business. This list is confidential and will only be used by the North Las Vegas Police Department for official business.

Please print or type legibly in blue or black ink. Date: ________________________________ Select one of the following:

New Business

Type of Business ____________________________________

Information Update (Change of Ownership for Business Previously Licensed in North Las Vegas, Change of Address for Business Previously Licensed and Located in North Las Vegas, Change of Phone Number, or Change of Emergency Contact)

BUSINESS INFORMATION Business Name:

Phone:

Business Address Street:

Suite:

City:

State: Zip:

In case of an emergency such as fire, burglary, vandalism, etc. while business is closed; please contact one of the following: (Please list at least two contacts.)

EMERGENCY CONTACT INFORMATION Name of Contact:

Local Phone Number:

Name of Contact:

Local Phone Number:

Name of Contact:

Local Phone Number:

Is your business operated out of your residence: Yes

No

If no, what are your normal hours of operation?

Open Close

Sunday

Monday Tuesday Wednesday Thursday

Friday

Saturday

Approximately how many employees work at your business? __________

Would you like to receive the Police Department's free Business Watch Newsletter? Yes

No

Would you be willing to having the Police Department's K9 Unit train occasionally at your

business? Yes No

Revised 08/27/2018

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