Travel Permit Request Form

Travel Permits cost $25, which is to be paid at the time of pick up. The original travel permit must be returned to this office with the bottom portion completed by a local law enforcement agency in the community you were permitted to visit.
Supervising Officer *
Car
Going by Car *
Plane
Going by Plane *
Train/Bus
Going by Train/Bus *
Departure Time *
:
Arrival Time *
:
Departure Time
:
Arrival Time
:
Name/Relationship of People Traveling with You:
Destination
If unable to provide information contact PO
Date Leaving
Date Returning
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Contact Information

Jodi Merritt
Director

Ph.:  (503) 623-5226
Fax: (503) 623-5326
Oregon Relay TTY or Voice: 711

Office Hours
M-F 8:00 A.M. to 5:00 P.M.

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Polk County | 850 Main Street | Dallas, Oregon 97338