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Text File  |  1992-09-23  |  4KB  |  48 lines
  1.                                   Any Company                                 
  2.                                  No Name Street                               
  3.                                Anytown USA 08111                              
  4.                                                                               
  5.                                                                               
  6.                               SECURITY DEPARTMENT                             
  7.                                 BARRING NOTICE                                
  8. ______________________________________________________________________________
  9.                                                                               
  10.  Pursuant to Section XX-XXXX of the XXXXXXXXXXXXXXXXXXXXX Code, you are hereby
  11. notified that you are not permitted entry at Any Company, No Name Street,     
  12. Anytown, USA.                                                                 
  13.                                                                               
  14.  In the future, if you return to this establishment and gain entry, even if   
  15. accompanied or invited by a guest, you may be subjected to criminal           
  16. prosecution for unauthorized entry.                                           
  17.                                                                               
  18. Name: GREG JOHNSON                                                            
  19.                                                                               
  20. RESIDENCE: #123, 456 78 Avenue                                                
  21.            Anytown, USA 00000                                                 
  22.            (609) 555-5555                                                     
  23.                                                                               
  24. DESCRIPTION:                                                                  
  25. DOB: MM-DD-YY Age: 22                                                         
  26. Sex: Male  Ht: 6'02" Wt: 175                                                  
  27. Hair: BLOND  Eyes: BLUE                                                       
  28.                                                                               
  29. DISTINGUISHING FEATURES:                                                      
  30. SNAKE TATOO ON LEFT FOREARM                                                   
  31.                                                                               
  32. Identification: _____________________________________________________________Id
  33.                                                                               
  34.  The above-mentioned "BARRING NOTICE" has been read to me by the Security     
  35. Officer and after reading the "BARRING NOTICE" for myself, I fully understand 
  36. its meaning.                                                                  
  37.                                                                               
  38. I do hereby voluntarily, without duress, threats, or force sign this statement.
  39. _______________________________________________________________________________
  40.                                                                                
  41.                                            ___________________________________
  42.                                            SIGNATURE                    DATE   
  43. WITNESSES:_________________________________                                    
  44.                                                                                
  45.           _________________________________ ___________________________________
  46.                                             SECURITY OFFICER                   
  47. Incident # 36 0000 Occurrence Date: MM-DD-YY                                    
  48.