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FULTON COUNTY SHERIFF'S OFFICE (County of Fulton)

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U.S.A. forms for County of Fulton

BROWSE COUNTY OF FULTON (NY) FORMS

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FULTON COUNTY SHERIFF'S OFFICE
2712 STHWY 29, JOHNSTOWN, NY 12095 | (518) 736-2100 | Fax (518) 736-2126
REQUEST FOR SECURITY CHECK
OWNER'S NAME: ___________________________________________________________________________
911 ADDRESS: ______________________________________________________________________________
HOME PHONE: _______________________________ BUSINESS: _____________________________________
DEPARTURE DATE: ____________________________ RETURN DATE: _________________________________
OWNER VEH PLATE NBR: _______________________ OTHER: _______________________________________
EMERGENCY
NOTIFICATION: ______________________________ TELEPHONE____________________________________
ADDRESS: ___________________________________ CITY:__________________________________________
Will anyone be working of have access to the premises during your absence? YES: ___ NO: ___
If yes NAME: _________________________________ ADDRESS: _____________________________________
PHONE #: __________________________________ BUSINESS #: ____________________________________
TYPE OF PREMISES: RESIDENCE: _________________ BUSINESS: _____________ OTHER: _________________
TYPE OF BUILDING: ___ CAMP ___ Small ___ Large TRAILER: ________________ OTHER: _________________
E911 ADDRESS: ____________________________________________________________________________
DETAILED LOCATION: ______________________ MILES ____ FEET FROM: _______________________
ROAD/HIGHWAY /STREET.
SIDE OF ROAD: ___________ COLOR: ___________ GARAGE: YES____ NO____
OTHER INFORMATION: _______________________________________________________________________
ALARM: ____YES: ____ NO: TYPE: _____________________________________________________________
LIGHTS: ____YES: ____ NO: LOCATION: ________________________________________________________
TIMER: ____ AM ____ PM
I REQUEST A SECURITY CHECK BE MADE OF MY PREMISES AND AGRESS TO NOTIFY THE FULTON COUNTY
SHERIFF'S OFFICE UPON MY RETURN.
REPORT MADE BY: --------------------------
HOW: ___ IN PERSON ___ LETTER ___TELEPHONE
OFFICER RECEIVING REPORT: __________________________________________________________________
TIME: _____________ DATE: _________________________ CASE #: ______________________________
CANCEL DATE: __________________ TIME: _________________ OFFICER: ___________________________
Revised 04/24/04
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FULTON COUNTY SHERIFF'S OFFICE (County of Fulton)

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Completed 13 February 2021

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