Atlantic
Broadband LEA Emergency Request Authorization Form
(To be completed by Law Enforcement Only)
Please call (814) 534- 8150 before faxing
a signed copy of the Emergency Request Form to (814) 410-2752
Identity of
Requesting Party
LEA____________________________________________________
Representative____________________________________________
Address__________________________________________________
Phone______________ Cell__________________
Fax________________ Email_________________
Nature and Extent of Emergency________________________________________________________
____________________________________________________________________________________
Customer
Information Sought__________________________________________________________
____________________________________________________________________________________
Customer Identification (i.e. name, address, email, IP
address, telephone number) ______________
____________________________________________________________________________________
Interception of Communication Sought (if applicable)______________________________________
Purpose of
Interception_______________________________________________
Type of
Interception_________________________________________________
Duration of Interception (Request
over 48 hours cannot be honored without a court order)
_________________________________________________________________________________
Has court order been requested?
_________ Name of Court_________________
If not requested, when will it be
requested? ______________________________
Indemnification
The requesting party acknowledged that this request
is made solely as a result of an imminent threat to life or of serious bodily
harm and that the information shall not be obtained shared or disseminated for
any unlawful or harmful purpose. Requesting party affirms the above
information, represents he has the authority to execute this form and agrees to
indemnify and hold Atlantic Broadband, its subsidiaries, employees, and agents
harmless for any claim, demand, loss or injury, including attorneys’ fees
brought against Atlantic Broadband by a third party, including the subscriber,
as a result of Atlantic Broadband’s compliance with this request.
________________________________
Law
Enforcement Signature
________________________________
Date
Please call (814) 534- 8150 before faxing
a signed copy of the Emergency Request Form to (814) 410-2752
LETTER OF AUTHORIZATION FOR CALL TRACE
(To be completed by Atlantic
Broadband customer)
To Whom It May Concern:
By
this letter I authorize Atlantic Broadband to establish a call trap on
telephone number _______________ for the purpose of determining the identity of
the person or persons responsible for making nuisance, harassing, or
threatening telephone calls to the above number.
I
agree to prosecute the person or persons apprehended as a result of information
obtained through the trap and trace procedures performed on my behalf.
I
have filed a complaint with my local law enforcement agency and the following
information is provided:
a.
Name of law enforcement
agency:________________________________
b.
Address of law enforcement
agency:______________________________
c.
Telephone number:
___________________________________________
d.
Fax
number:_________________________________________________
e.
Case/ Complaint
Number:______________________________________
f.
Investigating
Officer:__________________________________________
g.
Investigating Officer
Email:_____________________________________
I understand that any information obtained as a result of the trap and
trace will be provided only to the law enforcement agency named above.
Customer Signature:_____________________________________________
Name:________________________________________________________
Agency:_______________________________________________________
Date:__________________________________________________________