Elm Grove Police Department, 13600 Juneau Blvd., Elm Grove, WI 53122
262-786-4141

Date of Request:*

Name of Requestor:*

Phone number of Requestor:*

Name of Organization: (if applicable)

Address of Event:*

Reason for use:*

Number of signs requested:*

I understand that these signs are for use in the Village of Elm Grove and are not to be given to any other person or organization. These signs cannot be kept for more than seven (7) days without prior approval of the Police Department.

I agree to return all signs to the Elm Grove Police Department no later than this date.
*

I further understand and agree that if for any reason, I do not or cannot return these signs, I am responsible for the replacement cost of the sign(s). I also understand and agree that if the signs are returned damaged, I am responsible for the cost of repairing the damaged signs.
Metal Sign Post $3.50/each
Plastic sign $2.50/each
Total $6.00 each

*

I have read and agree to the conditions stated above.

Print this form and bring it to the Police Department to pick up the temporary signs.

- FOR OFFICIAL USE ONLY -

Officer granting extension:

Date extension is granted:

New Return Date:

Date signs returned:

Received by: