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2. Fate Department of Public Safety Request for Vacation House Check
   All Vacation/House Watch services of a residence will be for a maximum of Fourteen (14) consecutive days. All active Real Estate (sale/rental/lease/foreclosure) properties are excluded. Fate Department of Public Safety cannot guarantee your residence will be checked at specific times or dates, but every effort will be made to check on your residence as time and workload allow.
4. Type of Premise*
   -- Select One --HomeBusinessOther
6. First Name*
7. Last Name*
9. Address*
11. City*
12. State
13. Zip Code*
15. Phone Number*
16. Email Address*
18. Departure Date*
    Departure Date
19. Return Date*
    Return Date
20. Destination*
22. Emergency Contact Person*
23. Emergency Contact Phone*
25. Will anyone have keys or access to the premise?*

    1. Yes
    2. No
26. If yes, please provide name
27. If yes, please provide number
31. Additional Information

    1. Lights Left On
    2. Mail Stopped
    3. Alarm System
    4. Vehicle in Driveway

    1. Dog in Yard
    2. Newspaper Stopped
    3. Alarm System Monitored

    Please check all that apply
32. Description of Vehicle (if left in driveway)
Leave This Blank:


34. 1. Receive an email copy of this form.
35. Email address

    This field is not part of the form submission.

36. Submit

* indicates a required field