MASSANUTTEN POLICE DEPARTMENT

 

                                                     REQUEST FOR SECURITY CHECK

 

 

NAME:                                  

 

ADDRESS:                              

 

PHONE:                  

 

DEPARTURE:                 

 

RETURN DATE:

 

 

 

 

HAVE YOU LEFT KEYS WITH ANYONE ?

 

   YES:                  NO:    

 

NAME:                           

 

ADDRESS:                            

 

PHONE:            

 

 

WILL ANYONE HAVE ACCESS TO YOUR PROPERTY DURING YOUR ABSENCE ?

 

 

YES        NO 

 

NAME AND/OR COMPANY:                                       

 

 

PHONE:                       

 

DO YOU HAVE PETS LEFT ON YOUR PROPERTY? IF YES, WHAT KIND AND WHERE LOCATED?                  

 

                                          

 

 

ARE LIGHTS LEFT ON: FULL TIME:      TIMER:   LOCATION(s):                                 

 

 

VEHICLES LEFT ON PROPERTY ?  YES:       NO:   (IF YES, NOTE TAG NUMBERS)

 

LICENSE TAG #                                                  LICENSE TAG #                                                      .                           

 

 

IN CASE OF EMERGENCY, DO YOU WISH TO BE NOTIFIED BY A COLLECT CALL ?                          

 

IF YES, C/O NAME:                                                              ADDRESS:                                                           .                                    

 

PHONE:                                                                     .                                                                                                 

 

REMARKS:                                                     

                                                                                       

 

                                       

 

The Massanutten Police Department offers to conduct house checks for residents who will be away on vacation, business, or other personal reasons. MPD, when possible will conduct a perimeter check of the outside of your home.

 

 I AGREE TO NOTIFY THE POLICE DEPARTMENT WHEN I HAVE RETURNED  (289-9431). I UNDERSTAND THAT MY PROPERTY WILL BE CHECKED BY AN OFFICER WHENEVER POSSIBLE.

 

NOTE: Signing below indicates that you wish for the officer to check the property. If the residence and or property is found to be unsecured, then a check within and secure the property, if possible. Signing below will also indicate if suspicious activity, unauthorized entry/use concerning the property will authorize the officer to investigate the activity.   

 

 

SIGN:                                                                                              DATE OF REQUEST:                                                                        .