Complete the following information and the police department will drive by your
property while you are on vacation.

Contact Information

Name:*

Address:*

City:

State:

Zip:

Phone Number:*

Email Address:

Vacation Information

Date Leaving:*

Date Returning:*

Please list individuals who will have access to your property during your vacation (e.g. gardner, pool care, house cleaner)*

Will your mail/newspapers be discontinued during your vacation?*

Yes

No

Are there any dogs on the property? If so, how many?*

Do you have any lights on?*

Yes

No

Location of Lights:

Any Vehicles in Driveway?*

Yes

No

Vehicle Descriptions (make, model, lic plate):

Alarm Company and phone number:

Emergency Contact Information

Name:*

Address:*

Phone Number:*

Does Emergency
Contact Have Key?*

Miscellaneous Information