2. For internal use only:
4. Name:
5. Map grid: ________
6. District: ________
8. Address:
9. Close patrol: 201____________
11. Sachse, Texas 75048
12. House check: 201____________
14. 
    
15. Taken by: ____________________
17. Please fill in the following information:
18. Today's date:
20. Address:*
22. Dates from:*
23. to:*
25. Resident's name:*
27. Phone no. (home):
28. (cell):
30. Local emergency contact name and number:
32. Address of emergency contact:
34. Keys left with contact?

    1. Yes
    2. No
36. Anyone at residence daily?

    1. Yes
    2. No
38. If yes, name/number:
40. Does this location have an alarm?*

    1. Yes
    2. No
42. If yes, is alarm monitored?

    1. Yes
    2. No
44. Is there a permit on file?

    1. Yes
    2. No
46. Inside lights left on?

    1. Yes
    2. No
48. Are lights on a timer?

    1. Yes
    2. No
50. Are there pets on site?

    1. Yes
    2. No
52. Type of pet(s):
54. Vehicles left on premises?*

    1. Yes
    2. No
56. Vehicle make/type/color:
58. Location of vehicle:
60. Vehicle make/type/color:
62. Location of vehicle:
64. Vehicle make/type/color:
66. Location of vehicle:
68. Will vehicle(s) be driven in your absence?*

    1. Yes
    2. No
70. If yes, person's name and number:
72. Special notations/additional information:
74. The house check is a service provided by the police department when you are away from your residence for at least three (3) calendar days, but not longer than thirty (30) calendar days. It is not for extended absences from your residence or for vacant homes.
76. This is a copy of the security check that you requested. Our officers make every effort to protect your property even without requests such as this; however, this request permits officers to pay special attention to your property during times of specific circumstances. Please do not hesitate to contact us when you need assistance in any way.
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78. 1. Receive an email copy of this form.
79. Email address

    This field is not part of the form submission.

80. Submit Submit and Print

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