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2. HOUSE CHECK REQUEST FORM

   If your home is vacated for an extended period of time (vacation, military deployment, spending seasons in other areas, vacant/for sale, etc.) and you would like an officer to check on the home, please complete the form below with as much information as possible. 

   Do NOT use this form for emergencies. If this is an emergency, dial 9-1-1.

4. Address*
6. City*
7. State*
8. Zip Code*
10. First Name*
11. Last Name*
13. Phone Number*
15. Reason for Check*
    -- Select One --VacationOther
17. If other, please specify:
19. Property Owner Name*
21. Begin House Checks*
    Begin House Checks
22. End House Checks*
    End House Checks
24. IN CASE OF EMERGENCY
26. Name*
28. Address*
30. City*
31. State*
32. Zip Code*
34. Phone Number*
35. Will emergency contact have a key?*

    1. Yes
    2. No
37. Will vehicles be at residence? *

    1. No
    2. Yes (if yes, list info below)
39. Make and Lic. #
40. Location
42. Make and Lic. #
43. Location
45. Does the house currently have any visible damage?*

    1. Yes
    2. No
46. If yes, please describe:
48. Is the house equipped with an alarm system?*

    1. Yes
    2. No
49. Does the emergency contact have the code to the alarm?

    1. Yes
    2. No
51. Will other people be checking on the property?*

    1. Yes
    2. No
53. First and Last Name
54. Phone Number
56. First and Last Name
57. Phone Number
59. First and Last Name
60. Phone Number
62. Additional Comments/Information
64. INTERNAL USE ONLY

    FORM RECEIVED BY:______________________

    DATE/TIME ___________     ____________

Leave This Blank:


66. 1. Receive an email copy of this form.
67. Email address

    This field is not part of the form submission.

68. Submit Submit and Print

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