OVERNIGHT PARKING ENTRY

DETAILS:

PLATE#:

Reason:

MAKE:

MODEL:

VEHICLE COLOR:

STATE:

ADDRESS #:

DIRECTION:

STREET NAME:

SUITE/UNIT:

CITY:

STATE:

ZIP CODE:

START DATE:

END DATE:

Please enter the Actual Calendar Date you wish to park on the street.

Click Here For Example

FIRST NAME:

LAST NAME:

PHONE #:

Email:

NOTES :

end date must be greater than start date Number of days selected exceed maximum allowed – please contact your local police department for approval.
The Date Selected has passed and no longer available for Overnight Parking. Please consider the "AM" hours and select the Actual Calendar Date required to park.

Add More Vehicles To This Entry

The plate numbers in additional vehicles have exceeded maximum days allowed

PLATE#:

MAKE:

MODEL:

VEHICLE COLOR:

PLATE#:

MAKE:

MODEL:

VEHICLE COLOR:

PLATE#:

MAKE:

MODEL:

VEHICLE COLOR:

PLATE#:

MAKE:

MODEL:

VEHICLE COLOR:

Parking Snow Ban

Due to current weather conditions, we are not accepting vehicles to be entered into our overnight parking database.

Please check back soon to submit your vehicle for future dates.

VACATION WATCH ENTRY

CONTACT INFO:

EMAIL:

First Name:

Last Name:

ADDRESS #:

DIRECTION:

STREET NAME:

SUITE/UNIT:

CITY:

STATE:

ZIP CODE:

PHONE #:

DETAILS:

START DATE:

END DATE:

DEPARTURE TIME:

RETURN TIME:

ALARM SYSTEM:

PET ON PREMISE:

PERSON VISITING:

LIGHTS ON:

EMERGENCY CONTACT:

EMERGENCY PHONE:

EMERGENCY EMAIL:

Comments:

end date must be greater than start date Number of days selected exceed maximum allowed

CITIZEN REPORTING

INCIDENT DATE: *

INCIDENT TIME: *

INCIDENT TYPE: *

INCIDENT LOCATION:

ADDRESS/LOCATION: *

CITY: *

STATE: *

ZIP CODE: *

PERSONAL CONTACT INFO:

FIRST NAME: *

LAST NAME: *

DOB: *

SEX:

RACE:

ADDRESS #: *

DIRECTION:

STREET NAME: *

SUITE/UNIT:

CITY: *

STATE: *

ZIP CODE: *

TELEPHONE: *

EMAIL: *

Please enter valid email address

CONFIRM EMAIL: *

Email and Confirm Email should match

INCIDENT INVOLVES A VEHICLE:

PLATE NO:

MAKE:

MODEL:

YEAR:

COLOR:

BODY STYLE:

STATE:

VIN:

INCIDENT INVOLVES PROPERTY:

PROPERTY DESCRIPTION:(Describe the details of the property involved)

Report Narrative : *

IMAGE UPLOAD :
Image File Types Accepted: .jpg, .gif, .png, .tif, .pdf. Attachment should not exceed 10MB

BIKE MANAGEMENT ENTRY

CONTACT INFO:

EMAIL:

Registration Year:

First Name:

Last Name:

ADDRESS:

ADDRESS #:

DIRECTION:

SUITE/UNIT:

STREET NAME:

CITY:

STATE:

ZIP CODE:

HOME PHONE #:

CELL PHONE #:

DETAILS:

CITY LICENSE #:

BIKE SERIAL #:

BIKE MAKE:

BIKE MODEL:

BIKE COLOR:

FRAME SIZE:

FRAME TYPE:

IMAGE UPLOAD :
Image File Types Accepted: .jpg, .gif, .png, .tif. Attachment should not exceed 10MB

PET MANAGEMENT ENTRY

CONTACT INFO:

EMAIL:

FIRST NAME:

LAST NAME:

ADDRESS:

ADDRESS #:

DIRECTION:

SUITE/UNIT:

STREET NAME:

CITY:

STATE:

ZIP CODE:

HOME PHONE #:

CELL PHONE #:

DETAILS:

PET LICENSE #:

RABIES TAG #:

MICRO CHIP #:

ANIMAL TYPE:

BREED:

ANIMAL COLOR:

ANIMAL SEX:

ANIMAL NAME:

SPAYED / NEUTERED:

COLLAR DESCRIPTION:

Pet Status:

Lost Found/Impound Declared Dangerous

NOTES :

IMAGE UPLOAD :
Image File Types Accepted: .jpg, .gif, .png, .tif. Attachment should not exceed 10MB

KEY HOLDER ENTRY

COMPANY INFO:

BUSINESS NAME:

BUSINESS EMAIL:

BUSINESS PHONE#:

ADDRESS #:

DIRECTION:

STREET NAME:

SUITE/UNIT:

City:

State:

ZIP CODE:

KEY HOLDER INFO:

NAME (KEY HOLDER 1):

TITLE:

HOME PHONE # (KEY HOLDER 1):

CELL PHONE # (KEY HOLDER 1):

EMAIL (KEY HOLDER 1):

NAME (KEY HOLDER 2):

TITLE:

HOME PHONE # (KEY HOLDER 2):

CELL PHONE # (KEY HOLDER 2):

EMAIL (KEY HOLDER 2):

NAME (KEY HOLDER 3):

TITLE:

HOME PHONE # (KEY HOLDER 3):

CELL PHONE # (KEY HOLDER 3):

EMAIL (KEY HOLDER 3):

ALARM INFO:

ALARM COMPANY:

ALARM#:

ALARM COMPANY PHONE #:

ALARM PANEL LOCATION:

KNOX BOX LOCATION:

COMMENTS :

KEY HOLDER ENTRY

Residence Info:

Residence has surveillance cameras

RESIDENCE NAME:

RESIDENCE EMAIL:

RESIDENCE PHONE#:

ADDRESS #:

DIRECTION:

STREET NAME:

SUITE/UNIT:

City:

State:

ZIP CODE:

KEY HOLDER INFO:

NAME (KEY HOLDER 1):

HOME PHONE # (KEY HOLDER 1):

CELL PHONE # (KEY HOLDER 1):

EMAIL (KEY HOLDER 1):

NAME (KEY HOLDER 2):

HOME PHONE # (KEY HOLDER 2):

CELL PHONE # (KEY HOLDER 2):

EMAIL (KEY HOLDER 2):

NAME (KEY HOLDER 3):

HOME PHONE # (KEY HOLDER 3):

CELL PHONE # (KEY HOLDER 3):

EMAIL (KEY HOLDER 3):

ALARM INFO:

ALARM COMPANY:

ALARM #:

ALARM COMPANY PHONE #:

Comments:

Submit

AT-RISK RESIDENTS ENTRY

PERSONAL CONTACT INFO:

FIRST NAME:

LAST NAME:

DOB:

NICK NAME:

ADDRESS #:

DIRECTION:

STREET NAME:

SUITE/UNIT:

City:

State:

ZIP CODE:

ID #:

IDENTIFYING SCARS, MARKS, TATTOOS:

BEST METHOD OF COMMUNICATION:

Sex:

Race:

HOME PHONE:

CELL PHONE:

HEIGHT:

WEIGHT:

HAIR COLOR:

EYE COLOR:

IMAGE UPLOAD :
Image File Types Accepted: .jpg, .gif, .png, .tif. Attachment should not exceed 10MB

EMERGENCY CONTACTS:

NAME (EMERGENCY CONTACT 1):

HOME PHONE # (EMERGENCY CONTACT 1):

CELL PHONE # (EMERGENCY CONTACT 1):

EMAIL (EMERGENCY CONTACT 1):

RELATIONSHIP (EMERGENCY CONTACT 1):

NAME (EMERGENCY CONTACT 2):

HOME PHONE # (EMERGENCY CONTACT 2):

CELL PHONE # (EMERGENCY CONTACT 2):

EMAIL (EMERGENCY CONTACT 2):

RELATIONSHIP (EMERGENCY CONTACT 2):

NAME (EMERGENCY CONTACT 3):

HOME PHONE # (EMERGENCY CONTACT 3):

CELL PHONE # (EMERGENCY CONTACT 3):

EMAIL (EMERGENCY CONTACT 3):

RELATIONSHIP (EMERGENCY CONTACT 3):

MEDICAL CONTACT INFORMATION:

DOCTOR'S NAME:

DOCTOR'S PHONE #:

MEDICAL CONDITION:

LIST OF MEDICATIONS:

ADDITIONAL DETAILS:

FAVORITE PLACES TO EAT, VISIT, HANG OUT:

METHOD OF TRANSPORTATION:

ANY USUAL HABITS:

COMMENTS:

AT-Risk Residents

I understand that participation in the elmont Police Department’s At-Risk registry is voluntary. The information I provide including any medical history, diagnosis, medication and any other information that is protected by HIPAA is of my choosing. I further understand that the Belmont Police Department will not disclose this information and its sole use is for emergency response. This information will be used by emergency responders only in order to assist them in their duties. I further understand that I can withdraw this information from the program at any time.

** Please consider attaching a photograph of the at-risk individual. A photo is one of the most important tools we can use when attempting to locate or identify a missing person **

Close I AGREE TO THE DISCLAIMER(Take me to the online form)

Belmont Police Department

November 22, 2024

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