
TO: FROM:
_____________________________ _____________________________
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_____________________________ _____________________________
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_____________________________ _____________________________
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_____________________________
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DATE: _______________________
This to formally notify you that you are not to enter or remain
on my property, which is located at:
____________________________________________________________________________________
Should you enter or cross my property, you may be arrested without a warrant.
This form is to be brought to the Police Department AFTER service was made by method below:
Certified Mail (return receipt attached)
Service by Sheriff or Constable In-Hand Agent: ___________________
Name and Title: ______________________________________________________
Date & Time Served: ________________________________
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