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EMERGENCY ALERT
STAGE 1 Water Use Restrictions In Effect
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Out of Town - Extra Patrol
This form has been modified since it was saved. Please review all fields before submitting.
Please complete the Out of Town form, print and return to dispatch at the Police Department.
Name:
*
Address
*
Phone
*
Date of Request
*
Reason For Extra Patrol
Premise will be
-- Select One --
Vacant
Occupied
Type Premises
-- Select One --
Residence
Business
Alarm
-- Select One --
No
Yes
Lights On
-- Select One --
No
Constant
Automatic
Pets - Type, inside/outside, do they bite?
Keys left with:
In Case of an Emergency, Contact:
*
Others that will have access to premises (Relatives, Workers, Neighbors, Employees)
Description of Authorized Vehicle(s)
I request a security check on the above address , for the dates listed below.
From:
*
To:
*
SIGNATURE:
Leave This Blank:
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