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3. Request Type

   1. House Watch
   2. Concentrated Patrol
5. Home Owner/Renter Name
7. Address
9. Phone Number
11. Dates of Extra Patrol
    Dates of Extra Patrol Start Date

    —

    Dates of Extra Patrol End Date
    30 days
13. Is someone staying at the residence in your absence?

    1. Yes
    2. No
15. Emergency Contact
17. Address
19. Will emergency contact have a key?

    1. Yes
    2. No
21. Vehicles left at residence:
23. Lights left on?

    1. Yes
    2. No
24. On a timer?

    1. Yes
    2. No
26. Location of Lights Inside
28. Burglar alarm?

    1. Yes
    2. No
29. If yes, name of company:
31. WIll alarm reset automatically?

    1. Yes
    2. No
32. Local siren?

    1. Yes
    2. No
34. Maid service or maintenance workers?

    1. Yes
    2. No
35. If yes, name(s):
37. Pets:

    1. Yes
    2. No
38. If yes:

    1. Inside
    2. Outside
    3. Both
39. Type of pet(s)
41. Do you have a fenced yard?

    1. Yes
    2. No
42. Closest neighbor contact?
44. Will you be out of town? *
45. Phone number you can be reached at while out of town:
47. Notes for Concentrated Patrol/Additional Info for House Watch
49. Signature
50. Date
    Date
55. I, the undersigned, authorize the Grovetown Department of Public Safety to issue a warrant in my name to anyone at my residence in the commission of a crime or vandalism of my property during my absence.
57. Signature
58. Date
    Date
60. Witness
Leave This Blank:


62. 1. Receive an email copy of this form.
63. Email address

    This field is not part of the form submission.

64. Submit

* indicates a required field