Property Owner/Manager & Property/Business Information
California Driver's License #: _________________________________________________________________________________________________
Date of Birth:__________________________________________________________________________________________________________________
Address:_______________________________________________________________________________________________________________________
Contact #:_____________________________________________________________________________________________________________________
Email address:________________________________________________________________________________________________________________
PLEASE INCLUDE ONE PICTURE OF ONE OF YOUR POSTED SIGNS
S A N T A A N A P O L I C E D E P A R T M E N T
LIMITED AUTHORIZATION FOR ARREST
I hereby authorize the Santa Ana Police Department to arrest any person who trespasses upon my
property at
which is fenced, or posted with signs no less than 3 to a mile, along all entries and exterior
boundaries, or neither posted nor fenced and/or in any way engages in, carries out or causes to carry out
any unlawful act in violation of the law of the State of California or the City of Santa Ana’s Municipal Code.
I specifically designate the Santa Ana Police Department as my agent and grant authority to police
officers to request persons who are trespassing to leave the above reference property. (Penal Code
section 602 and 647.) I also agree to cooperate fully with any prosecution brought by or on behalf of law
enforcement authorities acting at my request and I agree to appear in court if called to do so. I
understand this authorization is for a limited time and that the time period will not exceed 6 months
when the property is not posted and when the owner, agent or person in lawful possession is absent
from the property. If the property is closed to the public and posted “Closed to the Public, No
Trespassing”, the period of time will not exceed six months. I further understand that it will be my
responsibility to renew my request once that time has expired. I will hold harmless the City of Santa Ana
for any act as a result of this request. I will renew this authorization or allow it to expire within 6
months of the date signed. I agree to notify the Santa Ana Police Department in the event I sell or
relinquish ownership, agency or lawful possession of the property.
Printed Name
Signature Date
Business /Property Name or Type:___________________________________________________________________________________________
Business /Property Address:__________________________________________________________________________________________________
City, State, Zip:_________________________________________________________________________________________________________________
Business Contact #:___________________________________________________________________________________________________________
Business Cell#:________________________________________________________________________________________________________________
Email address:_________________________________________________________________________________________________________________
Business/property will be closed between the hours of: _____________________________________________________________________
Describe Trespassing Issues:
_________________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________
Witnessed By:
Date Received by SAPD:
(May Be Same As Officer Taking Report)
FOR OFFICE USE ONLY
Case #: Expiration Date:
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