General Instructions To The Sheriff Of Ventura County Form Page 2

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Please provide the following information about the person (as best known to you):
4
Do you know of any illegal activity that may be taking place at the address(es)?
No
Yes
Describe: _____________________________________________________________________________________
5
Do you know of any prior police contact at the address(es)?
No
Yes
Describe: _____________________________________________________________________________________
6
Please provide additional information on any issues that may pose a threat to law enforcement:
Violent or criminal history:
UNK
NO
YES - explain: _________________________________
Firearms or other weapons:
UNK
NO
YES - explain: _________________________________
Gang involvement:
UNK
NO
YES - explain: ________________________________
Illegal drug use:
UNK
NO
YES - explain: ________________________________
Threats made:
UNK
NO
YES - explain: _________________________________
Surveillance cameras:
UNK
NO
YES - explain: _________________________________
Previous suicide attempts:
UNK
NO
YES - explain: _________________________________
Vicious animals (list):
UNK
NO
YES - explain: _________________________________
Alarms:
UNK
NO
YES - explain: _________________________________
7
Signature of Requestor: ________________________________________________ Date: _______________
Printed name of Requestor: _____________________________________________________________________
Address: _____________________________________________________________________________________
Street
Apt./Suite #
City
State
ZIP
Phone #: _____________________________________Fax #: ______________________________________
VCSO General Instructions (REV April 2015)
Page 2 of 2
Civil Office Use Only:
CC
Payment:
Cash
Personal Check#____
Business Check #____
FW‐003
RECD BY: _____

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