I hereby authorize the Lady Lake Police Department, it's officers, or other designated persons and employees to use this information in locating and returning the listed applicant to his/her residence should he/she become a lost/missing person or disoriented. I further authorize the Lady Lake Police Department to release the listed information in this or other related documents to other emergency agencies but then only on an "as needed" basis should it become necessary for them to assist in aiding the Vulnerable Registry person.
If registry for this individual becomes no longer necessary or if the listed information should change, I will notify the registering agency at the earliest possible moment. I understand that giving false information to a Law Enforcement Agency is a violation Florida State Statutes regarding the filing of false reports and I also understand that enrollment into this registry is a privilege not to be abused nor is it intended to deprive any individual from their right to privacy or freedom, but rather to assist the Vulnerable Population.
I acknowledge having read the above information. Furthermore, I fully understand and agree with its contents.
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By submitting this form I certify the information I provided is true and accurate to the best of my knowledge.
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409 Fennell Boulevard
Lady Lake, FL. 32159
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