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Residential Security Check Form

  1. Enter the date that you will leave the residence and the date that you will be returning.

  2. If you have a security alarm system or electronic door locks, this is where you would enter the code(s) to allow police/fire access in case of an emergency.

  3. Will any vehicles be left at residence?*
  4. Example: 2018 Ford Explorer, blue with black trim.

  5. Will any animal/pets be left at residence or in the yard?*
  6. Example: Tony, 9 yr old Boston Terrier, black and white. Trixie, 3 yr old Calico cat, orange and white.

  7. Will any lights be left on or on a timer?*
  8. Example: Carport light will be on. Front living room lamp is on a timer and will be on from 6pm until 11pm.

  9. Example: My brother, Jason Simmons, will be checking my mail and property. I have my lawn mowed on Wednesdays by ACME Landscapers.

  10. Disclaimer:

    Emergency contact information is required.  Please, have someone pick up your mail and packages, or have the service stopped.  The Havelock Police Department is not responsible for your  home and only offers this service as a courtesy.  The Havelock Police Department cannot guarantee that your home will be checked every day.  Any request longer than thirty (30) days will only be checked weekly.  If you return home prior to the date listed above, please contact the Police Department and notify them of your return.

  11. Leave This Blank:

  12. This field is not part of the form submission.