Resident Information

Requestor's Name:*

Business Name:

E-Mail:

Address:*

Date of Departure:*

Date of Return:*

Telephone # where you can be reached:*

Vehicles left at residence:

(Include make, model, color, license plate #, and state)

Vehicle #1

Location

Driveway Street Garage

Vehicle #2

Location

Driveway Street Garage

Vehicle #3

Location

Driveway Street Garage

Premise Information

(This information is ued for emergency contacts and emergency access to your residence if necessary)

Who has keys to residence?*

Address

Telephone Numbers*

Additional people with keys

Address

Telephone Numbers

Authorized Visitors

Examples: Relatives, lawn care workers, house keepers, pool workers, person(s) feeding animals, etc...

Names

Addresses

Telephone Numbers

Animals

Are you leaving any animals at the residence we need to be aware of?

Type of Animals

Number of animals

Location of animals

In the house In the yard In a kennel

Security

Security precautions we need to know

Do you have a security alarm?

Yes No

If you have a security alarm, is it monitored?

Yes No

Please describe any lights you are leaving on:

Is there any damage to your residence now?

Yes No

If yes, please describe:

Have you had any recent problems we should be aware of?

Yes No I am not sure

If yes, please describe

Is there any additional information you think we might need to know?

Acknowledgement

I understand that this vacation house check request is NOT VALID until I am contacted personally by the Fayette County Sheriff's Office.

Yes
No