WOOD COUNTY SHERIFF’S DEPARTMENT JAIL DIVISION

OWNER/OCCUPANT PERMISSION FORM

I,______________________, give my permission for ______________________ to use my residence while participating in the Electronic Monitoring Program (EMP). I understand that I will have to abide by the following rules.

1. I agree to submit my place of residence to search at any time when requested by any Law Enforcement officer or Wood County Jail staff. This includes allowing them to enter my residence at any time to inspect EMP equipment and to see that the above named person is complying with the rules of the program.(Int.)________
2. I agree that at no time while the above named person is participating in EMP I will have any alcoholic beverages or illegal drugs in my residence.(Int.)________
3. I agree to remove all firearms from my residence while the above named person is residing here.(Int.)________
4. I understand that my phone line is not to be equipped with any special features(call waiting, call forwarding, caller ID, third party capabilities, Internet service or answering machine, cordless phone).(Int.)________                                                                                                                                                                                                                

Owner/Occupant name:____________________________________________________

Address:________________________________________________________________

City _____________       Zip_______________               County___________________

Phone number:________________________ Cell phone__________________________

___________________________              _____________________________                                                      Signature                                                     Date

___________________________              ______________________________

EMP Officer                                               Date