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Trespass Letter of Consent (TLC)

If submitting for a business or other range of addresses, please complete separate entries for each TLC address. Apartment complexes do not need to enter separate addresses for each apartment.

*What is the name of the business or location IN KEIZER for which you are seeking a TLC?

*Street address for TLC location (include suite or apt number)

*What is your name?

*What is your date of birth? This information is necessary to complete reports.

*What is your e-mail address? This will be the primary method for seeking annual renewals of the TLC.

*What is your phone number, including area code?

*What is your authority to file a Trespass Letter of Consent? (only one title needed)

For example: Owner, Manager, Employee, Supervisor

*What is YOUR mailing address? Include city, state, zip

Sometimes the police need to contact a responsible person after regular business hours. Please provide a 24-hour phone number for that person, if different from above.

If you are not the person the police should contact, provide that person's name. Please do not enter anything if that person is you and your info is entered above.

What is their authority to have a TLC enforced?

For example: Employee, Manager, Family Member, etc.

Generally, Keizer police officers will not enforce trespass laws at rented or leased housing except at the request of a responsible person on scene or for whom we have contact information provided above.

I hereby designate each and every police officer, now and hereafter, employed by the City of Keizer as my agent and representative for the purpose of enforcing Oregon Revised Statutes 164.245 and 164.255 (Criminal Trespass).

Unless canceled or revoked, a TLC authorization will continue in full force and effect until the end of the calendar year plus 30 days. Prior to the end of each calendar year we will solicit you for the following year's TLC. To cancel or revoke a TLC, contact Keizer Police Records at 503-390-3713.

By submitting this document with my typed signature, I authorize the Keizer Police Department to take action as set forth herein as if I had signed this form in person.

*Typed signature

*Date submitted

Confirm

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City of Keizer, Oregon

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City Hall
930 Chemawa Rd NE
Keizer, OR 97303
Phone (503) 390-3700

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