Using This Form: To save time filling out a form at the police department, just fill in the blanks and print this form and bring it into the Blooming Grove Police Department.  A Premise Check is for town residents going on vacation only, this is not to be used for homes that are unoccupied for extended periods of time or homes under construction. Please contact the headquarters  for any other circumstances. This form is NOT directed to the police department by way of the internet, it is strictly a form to print and return to the Police Department. Please bring proper ID when coming to the station.

Vacation Premise Check Form
Personal Information:
Name                                     
Residence Address                 
Telephone Number:                
Residence Description:    
Vehicles in Driveway: Vehicle 1         Vehicle 2
                                 Vehicle 3         Vehicle 4
Vacation Information:
Date Leaving:                          
Return Date:                            
Destination:                            
Contact Number:                     Second Number:
Alarm System:                         Yes   No
Alarm Resets:                          Yes   No
Alarm Company Name:          
Alarm Company Number:       
Key holder Name:                   
Key holder Address:               
Key holder Telephone Number:
Anyone working in residence:  Yes   No
Name:                                    
Telephone Number:                
Dates:                                    
Emergency Contact Information:
Do you wish to be contacted in the event of an emergency?  Yes   No
Additional Information:
                 
Signature:

Date:

Below lines for Police Department use only.
 
 
Member assisting Homeowner:
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