| Rutherford Police Department 184 Park Avenue Rutherford, New Jersey 07070 (201) 939-6000 |
| Emergency Contact Information |
| Return to the Rutherford Police Records Bureau |
| Name of Business: | _____________________________________________________ |
| Address: | _____________________________________________________ |
| Telephone (bus): | _____________________________________________________ |
| Mgr. or Owner of Business: | _____________________________________________________ Required - Circle One (MGR) (OWNER) |
| Mgr. or Owner of Home Address: | _____________________________________________________ Required - No PO Box - This is not for mailing |
| Mgr. or Owner Home Telephone: | _____________________________________________________ Required |
| First Call Name: | _____________________________________________________ |
| Address (FULL): | _____________________________________________________ |
| Home Telephone: | _____________________________________________________ |
| Second Call Name: | _____________________________________________________ |
| Address (FULL): | _____________________________________________________ |
| Home Telephone: | _____________________________________________________ |
| Third Call Name: | _____________________________________________________ |
| Address (FULL): | _____________________________________________________ |
| Home Telephone: | _____________________________________________________ |
| Tips: | Do not list two people at the same address - if we get no answer the first time calling the same number again does not help. List both names on same line if they live together. If the owner is the contact, fill in OWNER info and just write "Owner" on the contact line. The purpose of the form is to reach someone in case of EMERGENCY when the business is closed. This includes Fire, Burglary, Malicious Damage, Open Doors, etc. This is not an application for buisness license. |
| THIS INFORMATION IS NOT GIVEN OUT - IT IS FOR INTERNAL POLICE USE. | |