City of College Park
Premise/Vacation Check Request
Submit Completed Form via email to publicservices@collegeparkmd.gov
________________________________________ College Park, MD 20740
Single Family Home Town House Condo Business
_____________________________________________
Owner Tenant Other ________
______________________________
Vehicle(s) Left on Premises
Yes No How Many _____________
License No. _____________________________
Make/Model _________________________
License No. _____________________________
Make/Model _________________________
Yes, premise only; Yes, premise and vehicle No
______________________________________________________________________________
____________________________________________
Phone No.: ______________________
Will anyone be working at or have access to the interior of premises during your absence? Yes No
___________________________________________________________________________
_____________________________________________
Phone: ________________________
Will anyone be working at or have access to the exterior of premises during your absence? Yes No
______________________________________________________________________________
_____________________________________________
Phone: _______________________
Do you have an alarm company? Yes No
__________________________________________________________________________
_________________________________________
Phone: _______________________
Emergency Contact (local or where to reach you when you’re away)
______________________________________________________________________________
_____________________________________________
Phone: ________________________
Will you be leaving any lights or appliances on a timer? Yes No
Living/Dining Room Kitchen Upstairs Front Upstairs Back
Any special conditions or comments? ________________________________________________________
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By submitting this request I acknowledge that I am an owner or tenant or authorized party of the address provided above and
have informed the Prince George’s County Police Department through City of College Park Contract Police Program of my
intention to be away for the period entered. Further, I understand that this request will not substitute for security measures,
which I have the responsibility to exercise. In the event that I return to the property prior to the return date, the appropriate
parties will be notified. Officers will attempt to visit the premises daily for the duration of my absence unless circumstances
arise to preclude such inspection.
_______________________________________________ _____________________
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