Merchantville Police Department
REQUEST FOR SECURITY CHECK
**SECURITY CHECKS WILL BE CONDUCTED RANDOMLY AS PATROL AVAILABILITY ALLOWS**
Address to be checked - _____________________________________________________________________
Name(s) of Owner - ____________________________________________________________________
Contact Phone # - ______________ Departure Date - ______________ Return Date - ______________
Emergency Contact / Keys [ ] Yes [ ] No Will there be any lights left on / Timers? [ ] Yes [ ] No
If yes Name / Address / Phone # If yes Location in house & when they will be on.
__________________________________________ ________________________________________________
__________________________________________ ________________________________________________
__________________________________________ ________________________________________________
Will there be any vehicle on the property? [ ] Yes [ ] No Will anyone be working at or have access? [ ] Yes [ ] No
If yes Description / Tag / Where If yes Name / Address / Phone #
___________________________________________ ________________________________________________
___________________________________________ ________________________________________________
Parking Permit [ ] Yes [ ] No Mail & Paper Stopped? [ ] Yes [ ] No
I request a security check to be made of my premises and agree to notify you of my return.
__________________________________________________ ____________________
Signature of Person Requesting Security Check Date Requested