MOLALLA POLICE DEPARTMENT

 

Case Number: ___________

Date: __________________

 

VACANT RESIDENCE NOTIFICATION

 

 

Name: _______________________________________  DOB: ________________________

 

Address: ___________________________________________________________________

 

Home Phone: ________________________ Message Phone: _________________________

 

Date of Departure: _____________________ Date of Return: ________________________

 

Destination: _________________________________________________________________

 

Security System:  (No)  (Yes)   Lights on:  (No)  (Yes)  Timer:  (No)  (Yes)  Pets:  (No)  (Yes)

Papers Stopped:  (No)  (Yes)   Vehicles:  (No)  (Yes) – Describe ________________________

 

______________________________________________________________________________

 

Keys left with: ____________________________________ Phone: ______________________

 

Will anyone be working at, or have access to the premises:  (No)  (Yes) – Complete below

 

Name: ___________________________________________  Phone: _____________________

 

In case of emergency, do you wish to be contacted by phone?  (No)  (Yes) – Complete below

 

Care of name: _____________________________________  Phone: ____________________

 

 

Dear Resident:

 

This vacation house notification in no way guarantees that your property will be safe from vandalism or burglary, but merely provides the Police Department with information of your whereabouts and pertinent facts if a crime or emergency should occur.  Remember, your best defense against crime is a concerned neighbor reporting suspicious activity.

 

Have a safe journey, and please notify us of your return.

 

 

GERALD D. GIGER

CHIEF OF POLICE