Vacation House Check Form
URBANDALE POLICE DEPARTMENT
3740 86th Street PH:515-278-3938
Vacation House Check
Name: 
Address: 
Email:
Leaving Date:  Returning Date 
A key was left with 
Key Holder's Telephone Number  
Cell Phone: 
Is mail stopped?  Yes No
Are Lights left on?  Yes No
Is the garage locked?  Yes No
Any vehicles left on the driveway?  Yes No   If Yes How many?  
Does your residence have an alarm system?  Yes No
Company:
Comments:
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