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The below information will be used by Madrid police officers when conducting security checks on your property while you are away. Please complete as much of the information as possible so that the police department may better serve you while you are gone Return completed form to: Madrid Police Department, 304 South Water Street, Madrid, IA 50156 Address:_________________________________________________________ Dates to be away:_____________through _____________________ Name:___________________________________ EMRGENCY CONTACT NUMBER (Number where you can be reached while out of town): Phone # __________________________________________ proceed with a "C" if this number is a cell number Additional Information: House key left with a neighbor? [ ]YES [ ] NO (check one) If yes,Name: ____________________________________ Address: _________________________________ Vechiles left in driveway: [ ]YES [ ] NO (check one) If yes,describe: _________________________________________ _________________________________________ _________________________________________ Exterior lights on? [ ]YES [ ] NO (check one) If yes, are the lights on a timer: YES[ ] NO (check one) Interior lights on? [ ]YES [ ] NO (check one) If yes, are the lights on a timer: [ ]YES [ ] NO (check one) Will anyone be entering your home to water plants, pick up mail, feed pets etc? [ ]YES [ ] NO (check one) If yes, Name:______________________________________________ Address:_____________________________________________ PLEASE CONTACT THE MADRID POLICE DEPARTMENT AT 795-3113 AS SOON AS YOU |