Bristol Police Vacant Home Notice

Name at Residence:_______________________________________________________

Address:_________________________ Phone:_________________________________

Departure Date:____________________ Return Date:____________________________

Lights left on?: YES .. NO ..... Are lights on a timer?: YES .. NO

Newspaper Cancelled?: YES .. NO ...... Will Mail be picked up?: YES .. NO

Alarm in Home?: YES .. NO

In Case of Alarm or Emergency, Notify:

Name:___________________________________ Phone:_________________________

Address:________________________________________________________________

Name:___________________________________ Phone:_________________________

Address:________________________________________________________________

Who, if anyone, has a right to be on property?:

Name:___________________________________ Phone:_________________________

Address:________________________________________________________________

Name:___________________________________ Phone:_________________________

Address:________________________________________________________________

Any special instruction?:

______________________________________________________________________

______________________________________________________________________

(PD Use below this line)

Officer Taking Report:_____________________ ID #:____________ Date:___________

Zone:____________ VH Report #:___________