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2. You can submit a request in person at the police station or you can fill out the form below to submit a request. Please fill out the form as completely as possible. Requests submitted online will be contacted for verification.

4. Requested starting date of patrol
   Requested starting date of patrol
5. Requested ending date of patrol
   Requested ending date of patrol
7. Name of person requesting patrol
8. State the reason you will be away
10. Location type

    1. Home
    2. Business
12. Address to be patrolled
13. Mailing address if different from address patrolled
15. Telephone number of the address to be patrolled (leave blank if none)
16. If you know the telephone number of the location you will be staying, please list it here
18. If you will have a cell phone with you, please list the number here
19. If you have an emergency contact for the patrol, please state that person's name here
21. If you have an emergency contact, please provide a telephone number here
22. If you have authorized anyone else to be at the location while you are out, please list their names here
24. If you are leaving any lights on in your house or yard or have a timer on lights, please give a detailed description of the location of the lights that will be left on and what time the timers are set for
26. If any vehicles will be left on your property while you are gone, please list their license plate numbers
28. If you have any other special instructions to leave for the patrol, detail them here
Leave This Blank:


30. 1. Receive an email copy of this form.
31. Email address

    This field is not part of the form submission.

32. Submit

* indicates a required field