Vacation House Check Form

Clay Township Offices
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	Vacation House Check Form

Police Department
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For added security while you are away, you may complete the following form. Press "Submit" once you have completed all pertinent areas of the form. The completed form must be sent no later than seven (7) days before your departure date. A representative from our office will contact you within the next 24 to 48 hours to verify your information.

Your Information
First Name		Last Name
Phone Number	Example: (###) ###-####
Street Address
Depart Date	Example: MM/DD/YY	Return Date	Example: MM/DD/YY
Key holder Information
First Name		Last Name
Phone Number
Street Address
Vehicles in driveway (make/model/color) Example: Ford / Pickup / Green			License Tag
Vehicle # 1			State
Vehicle # 2			State
Vehicle # 3			State
Vehicle # 4			State
Will light(s) be left on? Yes No
Which rooms?
Is there an alarm system? Yes No

Press the "Submit" button below once you have completed the above form.

Last Modified: April 02, 2007 Clay Township, 8207 Arlington Rd., Brookville, Ohio 45309