| TO: |   |   |   |   |   |   |   | FROM: |   |   |   |   | 
| _____________________________ |   |   |   | _____________________________ |   | 
|  |  |  |  |  |  |  |  !" |  |  |   | 
|  |  |  |  |  |  |   |   |   |   |   |   |   | 
| _____________________________ |   |   |   | _____________________________ |   | 
| ##"$"!! |  |  |  |  |  |  | ##"$"!! |  |  |  |  | 
|  |   |   |   |   |   |   |   |   |   |   |   |   | 
| _____________________________ |   |   |   | _____________________________ |   | 
| "###%"! |  |  |  |  |  |  | "###%"! |   |   |   |   | 
|  |   |   |   |   |   |   |   |   |   |   |   |   | 
_____________________________
 "$ &"#'"()*" '#+"#,"-.
DATE: _______________________
This to formally notify you that you are not to enter or remain
on my property, which is located at:
____________________________________________________________________________________
Should you enter or cross my property, you may be arrested without a warrant.
This form is to be brought to the Police Department AFTER service was made by method below:
Certified Mail (return receipt attached)
| Service by Sheriff or Constable | In-Hand | Agent: ___________________ | 
|   |   |   | 
Name and Title: ______________________________________________________
Date & Time Served: ________________________________
 
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