Johnson County Sheriff's Office

Security Camera Registration & System Information Form
CONTACT INFORMATION
Registered Owner Name:   Is this a Business or Residence?   Name of Business:
   
     
Street Address:   Street Address Line 2
 
             
City:   Zip:   Phone:   Email Address:
     
     
If you have more than one address/location you would like to register we ask that you submit a separate form for each location.

CAMERAS
Number of cameras as location viewing public areas:
 
Please describe the location of each camera at the address that are facing or observing public areas, streets, sidewalks, parking lots, etc.
     
Camera 1
Camera 2
Camera 3
Camera 4
Camera 5
Camera 6
Camera 7
Camera 8
Camera 9
Camera 10
Camera 11
Camera 12
Camera 13
Camera 14
Camera 15
Camera 16
Camera 17
Camera 18
Camera 19
Camera 20
 

VIDEO RECORDING INFORMATION
Camera Quality
Video Recorded?

DVR Make/Model?
Minimum Retention Period
 
Other Recording Information

EMERGENCY CONTACT INFORMATION
Contact #1 Title
Phone Number Email

Contact #2 Title
Phone Number Email