Vacation House Request Form Last Updated: Thursday May 30 2013

Date of Request Territory Car #

Name Address

Dates:

Start End

Time:

Start End

Notifiy us 'immediately' if dates and/or times change.

Persons authorized on property (relatives/lawn care/pet care, etc)

Name Phone
Name Phone
Name Phone

Vehicles left on property

Year Make Model Color License #

Year Make Model Color License #

Year Make Model Color License #

Vehicle Alarms

I hereby request the Topeka Police Department to place the above location on their vacation watch list, for checking by the area car or VIPS patrol when possible. I understand the department cannot guarantee to check this location every hour or even every day, but that they will attempt to check this location as frequently as time permit. I understand and agree that the Topeka Police Department, the City of Topeka, and their agents and employees are released from any liability in connection with this gratuitous service. I will notify the department when I return to cancel this request.

Requested by
Address/Phone

© City of Topeka