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Entry Form 2010 Looking Beyond the License Plate
A National Law Enforcement Recognition Program

For observations occurring between June 1, 2009 and May 31, 2010
Entry Rules

OFFICER INFORMATION:
Note: (*) indicates required field.
First Name*  
MI  
Last Name*  
Rank*  
Badge No*  
Unit Assigned*  
Precinct or Substation*  
     
POLICE DEPARTMENT:
Name*  
Street*  
City*  
State*  
Zip*  
     

Note: For this entry to be considered by the judge, each of the following sections must be completed. Please do not state "see attached" and submit reports, etc. Attachments are encouraged, but concise descriptions are required.

Date incident occurred:

Describe the events leading to the stop or observation (license plate on wanted or hot list, exprired, damaged, dirty, unreadable, etc.):

Detail the result of the traffic stop (e.g., crime solved, apprehension of fugitive, suspect or criminal, etc.

Was the front plate used to identify the vehicle?
Yes         No

Please explain:

What time of day was the stop made?
Daytime     Nighttime     Low Light (a.m.)     Low Light (p.m.)     Low Light (other)

Please provide any additional information, including news clips, videos, reports, traffic stop program outline and publicity or public information release.

AGENCY HEAD INFORMATION:
(Form must be submitted by head of agency)
First Name*  
MI  
Last Name*  
Title*  
e-mail*  
Today's Date*   (MM/DD/YYYY)
Phone   (000-000-0000)
Fax   (000-000-0000)
     

The above information will be used to to respond to this request and in accordance with 3M's privacy policy

Police Officer - Looking Beyond the License Plate

Complete the form to the left, or click here for an Adobe Acrobat, PDF version of the form to be printed, completed and mailed in.

Questions about this form? Call 651-733-3847

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