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LYON COUNTY SHERIFF’S DEPARTMENT – 911 COMMUNICATIONS DIVISION RESPONSIBLE PARTY REPORT (775) 463-6620 INSTRUCTIONS: This report will assist the 911 Communications Center with making appropriate contacts in the event that your business or building is involved in a criminal event or other emergency incident. Please take a few moments to fill out this form and return it to: Lyon County Sheriff’s Department – 911 Communications Division 30 Nevin Way Yerington, NV. 89447 BUSINESS NAME: PHYSICAL ADDRESS (NUMBER AND STREET) CITY STATE ZIP MAILING ADDRESS (NUMBER AND STREET) SAME AS ABOVE CITY STATE ZIP BUSINESS NUMBER BUSINESS NUMBER BUSINESS FAX RESPONSIBLE PARTY INFORMATION Please list the names and telephone numbers of personnel that we can contact in the event there is criminal activity or other emergency at your business NAME HOME TELEPHONE CELL PHONE OTHER PHONE PAY TELEPHONE INFORMATION Please indicate if your business has public pay telephones, if so please provide us with the telephone number and location of each phone. This information helps us determine where to send help in the event that 911 is called from a pay phone Our business has no pay phones NUMBER LOCATION Do you have any other information about your business that we would need to know to ensure your safety as well as the safety of responding emergency services personnel?