COVINA POLICE DEPARTMENT
Vacation Extra Patrol Request
Please complete all fields which apply and submit to the police department.
Completed forms can be submitted to the department by fax, e-mail, in-person or US Mail to:
COVINA POLICE DEPARTMENT–CRIME PREVENTION
444 N. Citrus Ave. Covina, CA 91723
Fax: 626.384.5629 or E-mail: crimeprevention@covinaca.gov
Name: ____________________________________________________
Address: __________________________________________________
Cross Streets: ___________________ & ________________________
Dates Away: Leaving ________________ Returning ________________
(please check) House Condo Apartment Mobile Home
Property Information
1. Pool: Yes No
2. Lights: Yes No Location of Lights: _______________________
_______________________________________________________
3. Dog(s): Yes No (Other): _______________________________
4. Vehicle(s) at Premise: Yes No
License #: ________________ Make of Vehicle: ________________
License #: ________________ Make of Vehicle: ________________
5. Alarm Company Name: ____________________________________
Phone #: __________________________
Permitted on property
1. Gardener: Yes No
Name: __________________________________________________
Days: ______________________ Hours: _____________________
2. Pool Man: Yes No
Name: __________________________________________________
Days: ______________________ Hours: _____________________
Others permitted on property:
3. Name: _______________________ Phone #: ___________________
Has Keys: Yes No
4. Name: ______________________ Phone #: ___________________
Has Keys: Yes No
Notes
