Police – House / Vacation Check Request

PIERCETON POLICE DEPARTMENT
207 N. FIRST STREET
PIERCETON, IN 46562
574.594.2232

In our efforts to make the community safer and to reduce crime, the Pierceton Police Department offers this service free of charge. If requested, we will periodically check the exterior of your home to make sure all doors and windows are secured. We will contact you directly with any questions or concerns that arise.

Instructions: Please complete all sections of this form prior to submission. The information you list on this form will be kept confidential. If there are any changes to the information you provide, after submission, please contact the Pierceton Police Department at 574.594.2232 or police@pierceton.org

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Name *

First

Last

Street Address *

Phone

Email *

Reason for Request: *

• Vacation
• Extended Time Away
• Other*

Location of Premises

• Residence
• Business
• Other *

Requested date for the security check to start *

How long are you requesting the check to continue. *

Alarm System or Security Cameras?

• Yes
• No

What will be left on?

• Interior Lights
• Exterior Lights
• Television / Radio

Keys left with:

If you have left keys, please give us their Name, Address and/phone.

Do you wish to be contacted by phone in case of an emergency? *

• Yes
• No

* Additional Information

Submit