Request for Security Check (Dark House)

Currently:
December 10, 2019
10:53 PM

Request for Security Check (Dark House)

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By receipt of this security check request, the town and it's Police Department cannot (due to manpower and fiscal constraints) and do not represent, warrant or guarantee that the Police Department personnel will check, patrol or otherwise investigate your premises during your absence on a regular periodic basis, if at all. You are therefore advised to take all necessary precautions to secure your premises and possessions against intrusion and theft during your absence.

Please enter the following information:

First name:

Last name:

Address:

City:

State:

Zip Code:

Home Phone:

Business Phone:

Email:

Departure Date:

(mm/dd/yy)

Return Date:

(mm/dd/yy)

Destination:

Type of Premise:

Private Residence Business Other

Have keys been left with anyone?:

Yes
	Name:
	Address:
	Phone:

Will anyone be working about or have access to premises during absence?:

Yes
	Name(s):

In case of emergency do you wish to be notified by collect call?:

Yes
	C/O Name:
	Address:
	Phone:

Other Remarks: