NASHVILLE POLICE DEPARTMENT

208 N. MAIN ST.                                                                                                                                PHONE 517-852-9866

NASHVILLE, MI 49073                                                                                                                       FAX      517-852-9858

VACATION RESIDENTIAL PROPERTY CHECK REQUEST

By signing this form you are requesting the Nashville Police Department to check on you property for a disclosed period of time.

The Nashville Police Department is not responsible for loss or damage of your property.

PLEASE PRINT

Full Name: _______________________           Vehicle: ___________________________

Address: _________________________          Vehicle: ___________________________

Phone: __________________________           Vehicle: ___________________________

Alarm: _______________________________

Lights On: ____________________________

Light Timers: __________________________

Dog (s): ______________________________

Emergency Contact #1                                             
Should anyone be on the property, if so give name (s) below

Name: __________________________           ___________________________________

Address: ________________________            ___________________________________

Phone: __________________________           ___________________________________

Emergency Contact #2

Name: _______________________________

Address: _____________________________

Phone: _______________________________

Date Leaving: _________________________

Date Returning: ________________________

Can you be contacted by phone, if so please list below

Location: ________________________           Location: ___________________________

Phone: __________________________           Phone: _____________________________

Signature: ________________________            Date: ______________________________