OLIVETTE POLICE DEPARTMENT

VACATION CHECK

While you are out of town, you need not worry about your house.  Print and complete the attached form, present it to the Olivette Police Department and periodic checks will be made during your absence. 

RESIDENTS NAME:  _____________________________________________________________

ADDRESS:  _____________________________________________________________________

DEPARTURE DATE/TIME: _________________________  

RETURN DATE/TIME:         _________________________

EMERGENCY CONTACT:(This should be an individual still in town that will have your contact info while you’re away)

NAME: ___________________________________________

HOME NUMBER: __________________________________

WORK NUMBER: __________________________________

CELL NUMBER: ___________________________________

WILL THIS INDIVIDUAL HAVE AN AVAILABLE KEY?  Yes: ________         No: ________

VEHICLES:  (List any vehicles that will be left at your home and location)

1.  __________________________________________________

2.  __________________________________________________

3.  __________________________________________________

Please note ANY other information that an Officer may need to know about your residents.

1. Lights on timer:      Yes ____    No _____                          Location & Time: _________________________

2. Security Systems:  Yes ____    No _____                          Company:  ______________________________

                                                                                           Business #: _____________________________

3. Individuals w/permission to be at property:                        Names:  ________________________________

                                                                                                         ________________________________