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2. Name of Location
3. Type of Location
   Home, Business, Apartment, etc.
5. Location Address (if only submitting one address)
6. Zip Code
8. If you want to submit multiple addresses on one form, please upload a list here.
10. Company Name (if applicable)
12. First Name*
13. Last Name*
15. Mailing Address
17. City
18. State
19. Zip
21. Business Phone
22. Fax
23. Home Phone
24. Cell Phone
26. I certify that I have the authority to file such paperwork with the Monroe Police Department as the:*

    1. Owner

    1. Lessee

    1. Manager

    1. Other
28. By submitting this document I do hereby designate each and every police officer now or hereafter employed by the City of Monroe as agent for the purpose of enforcing Section 9.10.140 of the Monroe Municipal Code and RCW's 9A.52.070, 9A.52.080, 9A52.010(3), 9A.52.105 and 9A.52.115. This authorization shall continue in full force and effect until such time as it is revoked in writing and said writing is duly delivered to the Monroe Police Department.*

    I have read and understand the above.

    1. Yes
30. If you have any questions about this program, contact pdrecords@ci.monroe.wa.us.
32. Email address
Leave This Blank:


34. 1. Receive an email copy of this form.
35. Email address

    This field is not part of the form submission.

36. Submit

* indicates a required field