East Spencer Police Department
This form is to be used if you are going to be out of town of away from home for an extended amount of time and would like to have your home patrolled by the East Spencer Police Department. THis service is available to Town of East Spencer Residents only.
NOTE: This is a Secured form that can be accessed by the East Spencer Police Department ONLY.
Owner's Name: Telephone:
Date Leaving Town: (MM/DD/YYYY)
Date Returning Home: (MM/DD/YYYY)
Contact Person: Telephone:
Alarm System:Yes No Company: Telephone:
At this time I would like to request that the East Spencer Police Department perform routine House Checks at my residence located at
Brief Description of Home
The following person(s) are allowed to be at the residence during my absence:
The following person(s) are not allowed to be at my residence during my absence:
in case of emergency contact: (PLease include name, address and TelePhone Number)
More information and/ or comments