St. Albans Police Department

Violation: Possession of Tobacco by Minor

Title 7 V.S.A., Section 1005 - New legislation as of July 1, 1997, states school boards are mandated to adopt policies prohibiting the possession and use of tobacco products by students. These policies must include provisions for confiscation and appropriate referrals to law enforcement.

Violator Name: ___________________________________ DOB: __________________

Street: ___________________________________________ Phone: _________________

City/Town: _______________________________________ Zip Code:_______________

Parent Information: ____________________________________________________________

Date of Incident: ____________________________ Time of Incident: ______________

Location: _____________________________________________________________________

Tobacco confiscated: Brand _______________________ Quantity _______________

Remarks: ____________________________________________________________________

____________________________________________________________________

Witnessed by: _________________________________

(printed name)

_________________________________

(Signature)

Forwarded by Bellows Free Academy on:

c: Parent/Guardian, Main Office Student File, Suspension folder, Guidance Office

Official Use Only:

Assigned Officer: Date:

Disposition: