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LICKING COUNTY SHERIFF'S OFFICE

Business Registration Form

The Licking County Sheriff's Office remains ever vigilant in the suppression of crime and the apprehension of those who bring harm to our Community and its Businesses. In order to better serve you and keep our records up to date, please complete the form below if you are a business within Licking County that wishes to register your key holder information with us. Be assured that the information is confidential and will only be used for strict purposes at the Licking County Sheriff's Office. This information will be used to contact you if an emergency exists at your business.


There is a place for 3 contacts, but you must have 2. You may list any other important information in the notes field, i.e. security company.

 

Organization: *
Organization Address: *
Organization City: *
Organization Zip: 
Organization Phone: *
Organization Fax: 
  
1 Contact Last Name: *
1 Contact First Name: *
1 Contact Phone: *
1 Contact Mobile: 
1 Contact Pager: 
  
2 Contact Last Name: *
2 Contact First Name: *
2 Contact Phone: *
2 Contact Mobile: 
2 Contact Pager: 
  
3 Contact Last Name: 
3 Contact First Name: 
3 Contact Phone: 
3 Contact Mobile: 
3 Contact Pager: 
  
Notes: 

 

  

 

Please note that items marked with a " * "must be filled in to complete this form.


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