Vacation/Holiday Away Notification Form - Newtown Police Department

Newtown Police Department Vacation/Holiday Away Notification Form
First Name:		Last Name:
Street Address:		Email Address:
Home Phone: Enter as (XXX-XXX-XXXX)		Cell Phone: Enter as (XXX-XXX-XXXX)
Date Leaving: Enter Date as (mm/dd/yyyy)		Date Returning: Enter Date as (mm/dd/yyyy)
Lights left on in home?:		If yes, are lights on timers?:
Destination:
Destination Phone: Enter Phone as (XXX-XXX-XXXX)		Destination Cell Phone: Enter Phone as (XXX-XXX-XXXX)

Automobile left at home in the driveway?:

Vehicle #1 Year:		Vehicle #1 Make:
Vehicle #1 Model		Vehicle #1 Color:
Vehicle #1 License Plate:		Vehicle #1 License Plate State:

Vehicle #2 Year:		Vehicle #2 Make:
Vehicle #2 Model		Vehicle #2 Color:
Vehicle #2 License Plate:		Vehicle #2 License Plate State:

Vehicle #3 Year:		Vehicle #3 Make:
Vehicle #3 Model		Vehicle #3 Color:
Vehicle #3 License Plate:		Vehicle #3 License Plate State:

Name of person checking on the home:		Contact Number:Enter as (XXX-XXX-XXXX)
Address of person checking on the home:		Does this person have keys to the home?:
Does this person have the alarm code?:		Alarm Company Name & Number:

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