THOMAS TOWNSHIP POLICE DEPARTMENT

                                         REQUEST FOR SECURITY/HOUSE CHECK

          Date:____________

         From:_______________ To:_______________

         Destination:____________________________

         Name:________________________________

         Address:_______________________________Phone:___________

         Automatic Lights On:__________Where?_____________________

         Alarm:__________                        Animals Home:__________

         Will anyone be working at or have access to premises during absence?_______

         If yes, who?____________________________

         Address:__________________________________Phone:_________

         In case of emergency will someone have keys to home?___________

         If yes, who?____________________________

         Address:__________________________________Phone:_________

         Vehicles in driveway: Make/Model/License #:_______________________

                                              Make/Model/License #:_______________________
               

        The security/house check service does not guarantee that your property will be
        safe from burglary or vandalism, but merely provides the police department with
        information of your whereabouts and other pertinent facts if a crime should occur.

        I agree to a security check being of my premises and agree to notify the police
       department upon my return.
               
          Signed:______________________________Date:__________________
 

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