Merrillan Voluntary Surveillance Program

This form is for the Village of Merrillan Voluntary Surveillance Program. Should a crime or incident occur in your area, Law Enforcement may inquire about the availability of any footage that may assist in solving the crime or help with evidence. By entering your information you are advising the Village that you are willing to be contacted and to share this surveillance (video).

ALL INFORMATION SUBMITTED HERE IS PRIVATE AND CONFIDENTIAL

Name *

First

Last

Address *

Village of Merrillan Address

Phone Number *

A good number to reach you; ensure accuracy before submitting this form.

Email *

Your email address; ensure accuracy before submitting this form.

Type of Surveillance Available *

• Video
• Audio
• License Plate Reader (LPR)
• Infrared Video
• Other (specify below)

Select all that apply.

Coverage *

• Roadway
• Sidewalk
• General Public Area

Select all that apply.

Additional Details

Provide any additional details available.

Do you agree to participate in this program?

• Yes
• No

You may opt-out at any time by contacting us.

Submit