Eddystone Police Department

 

Vacation & Vacant Buildings

 

 

File Number: __________________________                        Date Received: _______________________

 

Day of Week: __________________________                       Hour Received: _______________________

 

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Name: ________________________________________      Phone # _____________________________

 

Address: ____________________________________________________________________________

 

Vacant from: ______________________________ to ________________________________

 

In case of emergency or trouble, notify: _______________________________________________________

 

Address: ______________________________________      Phone # _____________________________

 

Keys left at: ___________________________________       Name: ______________________________

 

Will there be any cars in front of house or in the garage: _____________     Color: ______________________

 

Make: ________________________  Model: _______________________ Tag # _______________________

 

Will anyone have access to the house to check on it: ___________ Name: ____________________________

 

Will mail be stopped: _________________ Will any lights be left on or timers in operation: _____________

 

Will any animals be left in house, if any, what kind: _____________________________________________

 

Location of persons on vacation: _____________________________________________________________

 

___________________________________________________________ Phone # _____________________

 

Remarks: _______________________________________________________________________________

 

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Reported to Officer or Secretary: ___________________________________ Badge # __________________