License Plate Reader Entry Form

Agency Name

Case Number

*First Name

*Last Name

Title

*Email

Phone

*License Plate

*State

*Reason for Request

Comments or Special Instructions

BY SUBMITTING THIS FORM, REQUESTING AGENCY IS ACKNOWLEDGING THE POLICIES & PROCEDURES OF THE LPR SYSTEM. CECOMS WILL CONTACT REQUESTING AGENCIES TO CONFIRM RECEIPT.

THIS PLATE WILL AUTOMATICALLY BE REMOVED FROM THE LPR DATABASE AFTER 30 DAYS. IF THE PLATE MUST REMAIN IN THE SYSTEM AFTER 30 DAYS, PLEASE CONTACT CECOMS TO GRANT AN EXTENSION.

New code

Please type the code above

Incorrect value for the captcha image