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Vacation/Security Check Form

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Vacation/Security Check Form

1. *


2. *


3. *

Complete Address

4. *

Departure Date

5. *

Return Date

6. *


7. *

House Lights:

On Off

Location of House LIghts

9. *

House Lights Automatic?

Yes No
10. *

Do you have a security system?

Yes No

If yes, what is the name of your security company?

12. *

Will anyone have access to your residence during your absence?

Yes No

If yes, please provide their name, address and phone number below

In case of emergency, call

14. *


15. *

Phone #

16. *

I request that a security check be made of my property/building. I understand that a security check conducted by the Mayville Police Department in no way guarantees that my property will be safe from vandalism or burglary, but merely provides the police department with information of my whereabouts if a crime should occur. I agree to notify the Mayville Police Department upon my return at (920) 387-7903.  (Please type your full name below as an electronic signature)