2. The premises known as (NAME OF BUSINESS) located at (ADDRESS OF PROPERTY), Bremerton, Washington is for the exclusive use of my Employees/customers/residents.
4. NAME OF BUSINESS (if applicable)
6. ADDRESS OF PROPERTY*
8. I hereby give the Bremerton Police Department authority to enter upon my property for the purpose of advising and if necessary, removing any and all trespassed persons from my property. I will cooperate with the Bremerton Police Department and the City Attorney's Office in the prosecution of any violations occurring on above referenced property, where a citation was issued or arrest was made. I also understand that this authorization places no duty on the Bremerton Police Department to enter or remove any trespassers.
10. This license and authorization shall stay in effect until revoked by me by written notice and delivered to Bremerton Police Department by the owner of the property or their representative.
12. Name of Premise Owner or Agent*
13. Date and Time
    Date and Time

    Date and Time
15. Address*
17. City*
18. State*
19. Zip*
20. Phone Number*
22. ELECTRONIC SIGNATURE*

    1. By clicking this box you are signing this form electronically.
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24. 1. Receive an email copy of this form.
25. Email address

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