Print form to use for:

Keeping Your Home Safe While You are Gone

(Forms can also be obtained at the Community Center)

Lot:                       Physical Address:                                                                 

Resident Name:                                                                                        

Will this be a Resident, Business, or Other?                                                      

Protected by an Alarm?                    Will there be lights on?                            

Anyone left with a key?          

If yes, Name and Telephone #:                                                                           

Other people who have access to your house?                                        

In case of an Emergency, whom do we contact?                                      

Request that a Security Check be made of the premises be done from:

                    To                       

Signature:                                                            Date: