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VACATION HOUSE CHECK REQUEST

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VACATION HOUSE CHECK REQUEST Powered By Docstoc
					           Whatcom County Sheriff’s Office
           311 Grand Ave.                                                      VACATION HOUSE CHECK REQUEST
           Bellingham, WA 98225
Instructions:        Complete the form below, sign at the bottom and return to the Whatcom County Sheriff’s Office within 10 days prior to
                     departing on your vacation.
 Last Name                                                    First Name                                          Full Middle Name



 Street Address                                                                    City                            State                 Zip



 Home Phone                                        Work Phone                                               Cell Phone



 VACATION CONTACT INFORMATION
 Vacation Contact Address                                    City                         ST          Zip        Contact Phone No.


 Date of Departure                                                      Date of Return


 Person(s) authorized to enter residence
 Name                                                        Relationship to you               Do they have a key?          Contact Phone No.
                                                                                                  Yes              No

 Name                                                        Relationship to you               Do they have a key?          Contact Phone No.
                                                                                                  Yes              No

 PREMISE INFORMATION
 Directions to House                                                               Description of House/1 or 2 Stories/Color/Fences/Etc.



 Are premises protected by an alarm?                        Name of Alarm Company                                          Phone No.
           Yes                  No

 Vehicles on Premises/License No.(s)



 What would you like done with your mail, packages and/or newspapers? (It is recommended to stop delivery until you return)



 Will any lights be left on? If so, which ones?



 Additional remarks:



 ACKNOWLEDGEMENT
 The undersigned does hereby grant and request the Whatcom County Sheriff’s Office to visually check the property listed above.
 The undersigned does hereby agree to hold harmless the Whatcom County Sheriff’s Office and its employees and agents for any
 and all claims for loss or damage to property that my be suffered by the undersigned through action or lack
 thereof by a representative of the Whatcom County Sheriff’s Office. Further, the undersigned understands and agrees that this
 is a voluntary, free service, does not create a special duty upon the Whatcom County Sheriff’s Office, will be provided only as
 time is available, and no guarantee is made nor assurance given against loss, theft or damage to premises.

 Signature                                                                                                       Date


                                                                                                                                                Rev. 2/09

				
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