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2. Registration Type*
   -- Select One --ResidentialBuisness
4. Name*
5. Email Address*
7. Address*
9. City*
10. State*
11. Zip Code*
13. Phone Number*
14. Extension
16. Number of External Camera*
17. Number of Days Video is Stored
19. Direction of Cameras
21. Disclaimer

    You will only be contacted by the Belle Plaine Police Department in the future if there is a criminal incident in the vicinity of your security camera. Police personnel, if necessary, may request a copy of any video captured by your camera, which may assist in the investigation of a crime.

    Nothing contained herein will be constructed to create an agency, joint venture, partnership or other form of business association between the parties. Any video recording provided to the Belle Plaine Police Department pursuant to The Camera Mapping Program shall be subject to The Minnesota Data Practices Act.

23. I have read the disclaimer and agree to the Terms of Use.*

    1. Yes
    2. No
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27. 1. Receive an email copy of this form.
28. Email address

    This field is not part of the form submission.

29. Submit

* indicates a required field