INVERNESS POLICE DEPARTMENT
VACATION WATCH/VACANT DWELLING FORM
Name:
Address:
Date Leaving: Date Returning: Today's Date:
Phone #3:
Vacation: For Sale:
Other:
Yes: No: Yes: No:Lights On? Timer On?
Yes: No:Vehicles on Driveway: Description/License Plate Number:
Name: Phone:
Key Holder Info:
Name: Phone:
Alarm Info:
Company Name:
Phone:
Other Pertinent Info:
The undersigned authorizes the Inverness Police Department access to the above premises at all times for the purpose of
investigating the outside areas of the premises for property well-being checks. The undersigned understands that the Village
of Inverness and its respective police officers, employees, and agents shall not be liable and are hereby released from liability
for any failure of service or damages that might result from its check on the property, vehicles or other property in or about
the premises.
Phone #2:
Signature
Instructions:
1. Fill out the requested information and sign the form.
2. Scan & e-mail to police@inverness-il.gov, fax to (847) 358-8774 or drop off form at the police station 1415
Baldwin Rd. Use the drop box if after hours.
3. Please notify the Police Department of any changes or if your return dates change at (847) 358-7766.
Phone #1:
Cameras?
Yes: No:
Name: Phone:
