2. For Official Use Only
   Officer: ____________________________ ID:________________ Control #: _____________
6. Name*
7. Date
   Date
9. Address1*
11. City*
12. State*
13. Zip*
15. Phone number where you may be reached*
17. Name of Emergency Contact*
18. Phone*
20. Date of Depature*
    Date of Depature

    Date of Depature
21. Date of Arrival*
    Date of Arrival

    Date of Arrival
25. Will someone have keys to your residence?*
    -- Select One --YesNo
26. If Yes, Name and Phone
28. Address of person with keys to your residence
30. Are any vehicles left on property?*
    -- Select One --YesNo
31. If so, description and license plate(s) of vehicles
33. Who may operate these vehicles?
37. Animals on property? *
    -- Select One --YesNo
38. Care provided?
    -- Select One --YesNo
39. Lights left on? *
    -- Select One --YesNo
40. Lights on a timer?*
    -- Select One --YesNo
44. Burglar alarm? *
    -- Select One --YesNo
45. Alarm type
    -- Select One --AudibleSilent
46. Alarm company name
48. Alarm company phone number
50. Any other information we should know?
54. Acknowledgement
    I hereby grant the Lake Dallas Police Department access to the property described herein for the purpose of conducting security checks. I understand that if the officers do not have a clean unobstructed access to all sides of the residence they will be unable to check the entire building.
56. Name
    Type name in lieu of signature.
57. Date
61. For Official Use Only

    Dear ________________________________,

    This form indicates the number of times you home was checked by members of the Lake Dallas Police Department. We are glad to be of assistance, and we hope we were able to increase your sense of security while you were away.

    
    

    Lt. Alan Sawyer

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64. Email address

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