Patrol Request

Name:   Date Leaving:
Address:   Date Returning:
Phone:   Alternate Phone:

Type of Request:

Type of Premise:
If Other:
Alarm System:
Type of Alarm:

Vehicle on Premises:
If Yes:
Make: Color: License Plate:

Dogs on Premises:

Is Address Plainly Visible:
If Yes:
If No, Describe House:

Keys Left with Anyone:
If Yes:
Name: Phone #

In case of an emergency, do you wish to be notified by collect call?
If Yes, Phone Where You Can Be Reached:

You are requesting Vacation Patrol for the above listed address and agree that the Liberty County Sheriff's Office is not liable for any damages found and/or property missing from the address listed above in your absence.