House Check Request Form

If you would like members of the department to check on your residence, please fill out the information

below. The information will be sent to the Patrol Commander who will ensure a security check of your home

is conducted in a timely manner. You will be contacted by phone by responding officers in the event they feel

something is wrong or have any questions.  (House Check requests cannot exceed 30 days in length)

All of the fields are required for submission.
If you leave an empty field, the form will not be sent.

Full Name:	Contact Number:
Address:	Date Leaving: Date Returning:
Licenese Plate Number of Vehicle(s) left at Residence:	What rooms will lights be left on if any?
Name of Person(s) Authorized to be at the location while you are gone:

You must verify form entry prior to submitting.
By entering the text as seen above then clicking "Verify Form Entry"