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VACATION/EXTRA PATROL CHECK REQUEST

SERVICE REQUESTED:

FILING ______LOT______

Vacation or Extra Patrol
_________________________________________________________

PERSON REQUESTING:
Address:
Phone:
(First and Last Name Please)

_________________________________________________________
________________________________________________________
Do you want a copy mailed to you upon return? Y N
_______________________________________________________
_______________________________________________________
Contact Person:
Phone:
Residence:
____________________________________________________

Business:
____________________________________________________
________________________________________________________
Date/Time of request:
Date to Start:
vDate to Finish:

PLEASE NOTIFY PATROL WHEN YOU RETURN.

INDICATE ANY AUTHORIZED VEHICLES:
Vehicle Year: Make: Model: Colors: Plate Number: Location:
________________________________________________________
_______________________________________________________
________________________________________________________

Please note: The Genesee Foundation and the Jefferson County Sheriff’s Office is not responsible for any damage to your home or property that may or may not have been noticed or reported during routine house checks conducted by Jefferson County Sheriff’s Office as part of their contract with The Genesee Foundation.

VACATION CHECK INFORMATION

PET(S)
TYPE:
____________________________________________________
ARRANGEMENTS FOR CARE: ____Yes____No

LIGHTS:
__________________________________________________

MAIL:
___________________________________________________

PAPER:
__________________________________________________

OTHER DELIVERIES:
__________________________________________________

ALARM:
__________________________________________________

CLEANING/MAINTENANCE:
___________________________________________________

TELEPHONE NUMBER WHERE YOU CAN BE REACHED IN CASE OF EMERGENCY:
__________________________________________________

__________________________________________________

CONTINUATIONS, EXPLANATIONS, OR NARRATIVE:
___________________________________________________

__________________________________________________

__________________________________________________

SIGNATURE OF RESIDENT: ____________________________________________________




SECURITY USE ONLY: Field Activity Log – Reference reported problem requested service
START DATE/TIME: FINISH: OFFICER: REMARKS/EXPLANATION:
________________________________________________________________
ON:                @                @

___________________________________________


ON:                @                @

______________________________________________


ON:                @                @

_______________________________________________


ON:                @                @

_______________________________________________


ON:                @                @

______________________________________________


ON:                @                @

_______________________________________________


ON:                @                @

_______________________________________________


ON:                @                @

_________________________________________________


ON:                @                @

_________________________________________________


ON:                @                @

____________________________________________________


ON:                @                @

________________________________________________________



SUBMITTING OFFICER: DIST/BEAT:

Activity log continued on new page? ___ Yes ___ No


Submitting Officer Signature & Unit
___________________________________________________

Approving Supervisor/Date & Time Reviewed
_______________________________________________

PAGE LAST UPDATED: FEBRUARY 2, 2004

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