Police House Check Request Form

When you will be away from your home for an exteded period of time the Police Department can provide a House Check for you. Please fill out the request form below and submit, if you wish to schedule a security check of your residence while you are away.

Please provide the following information:

Name *

Email *

Address *

City *

Phone *

Cell Phone

House Description *

Further Location Information

Departure Date and Time:

Return Date and Time:

Are you leaving Lights on or on Timers? Please give details of location in house:

Will any Vehicles be left on the property in the yard or garage? Please list detailed info including make, model, color and license plate #:

Will any Animals be left home? Please list the quantity, type, name and Caretaker Name and Phone #:

Does anyone have permission to be on the property in your absence? Please list Names and Phone #:

Additional Info?

Persons having Keys/Access to your property? Names and Phone #:

Contact #1 in Emergency - Name and Phone:

Contact #2 in Emergency - Name and Phone:

Where are you Staying while away? Please list Place, Address and Phone #:

Is your house Alarmed?

Yes

If yes, what is Alarm Company Name and Phone?

Leave this field blank

Contact Info

Phone:

Dispatch: (603) 547-2525
Office: (603) 547-2535

Fax:

(603) 547-2544

Emergency Numbers:

911

Address:

Police Station

14 Francestown Road

P.O. Box 165

Greenfield, NH 03047

United States

See map: Google Maps

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Police House Check Request Form