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Request for House Check

    The Martinsburg Police Department provides Security Checks (free of charge) for residents of the Borough or Huston Township who are on vacation or away from home for a while, to give you that extra “peace of mind”. Officers will check the exterior of the residence for suspicious activity, as time permits, and will contact you or a designated contact person in the event of a problem. To request a security check, please complete the following form or stop at the Police Department. If possible, please submit the form at least 10 days prior to your departure. If submitted electronically, a confirmation email will be sent to you verifying that it was received. Also, please contact our department when you return.

Municipality:

Please provide the following contact information:

First Name
Last Name
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Cell Phone
Home Phone
E-mail

Date of Departure:

-- mm/dd/yy

Scheduled Date of Return:

-- mm/dd/yy

Probable Route of Trip:

Type of Premises:

Have keys been left with anyone?

Yes
No

Emergency Contact 1 (Local)

First Name
Last Name
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Cell Phone
Home Phone

Emergency Contact 2 (Local)

First Name
Last Name
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Cell Phone
Home Phone

Will anyone be working around or have access to the premises while you are away?

Yes
No

If yes, please give names or explain:

In case of emergency, do you wish to be contacted?

Yes
No

If yes, where may we contact you?

First Name
Last Name
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country
Cell Phone
Home Phone
E-mail

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KLH
Copyright © 2003 [Martinsburg PD]. All rights reserved.
Revised: 05/05/08