[De Pere, WI] De Pere Police Department House Check Form

Section 1 of 1 in this document

Police Department House Check Form

As part of our ongoing efforts in crime prevention, the De Pere Police Department can provide extra checks to houses that are temporarily vacant due to reasons like vacations, moving, or longer term travel plans. If you would like to request extra checks of your house while you are away, please fill out the following form. It is important that you provide us with contact information for one or more keyholders if we discover a problem. Please also let us know who, if anyone, is allowed to be at the property while you are gone.

Phone Number

Departure Date

Return Date

Will anyone have permission to go on premises, if so, who?

In case of emergency, who shall we call?

Phone Number

Will any lights be left on and where? (location in the house)

Will anyone have permission to use the driveway or garage, if so, who?

Have you notified the mailman and stopped newspaper?

Yes

Will a neighbor keep an eye on your residence?

Yes

Do you understand that the De Pere Police assume no responsibility other than trying to safeguard your home?

Yes

Sign Here

First Name

Last Name

Choose how to sign

Draw Type

I agree to electronically sign and to create a legally binding contract between the other party and myself, or the entity I am authorized to represent.

Please notify the De Pere Police Department when you return. Our phone number is 920-339-4078

Police Department House Check Form

Full Name

Full Address

Full Name

Have you notified the mailman and stopped newspaper?

Will a neighbor keep an eye on your residence?

Do you understand that the De Pere Police assume no responsibility other than trying to safeguard your home?

Sign Here