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2. The North Miami Beach Police Department will conduct a check of your home while you are on vacation or out of town during the time frame listed in this request.
   
   This service will be provided only as time permits and no guarantee is made nor assurance given against loss, theft or damage to the premises.
   
   If your plans to leave change or you come home early after you have completed this form, please contact the police department at 305-949-5500 with the changes.
6. Resident Name*
8. Resident Address*
10. Departure & Return Dates*
    Departure & Return Dates Start Date

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    Departure & Return Dates End Date
12. Home Phone Number*
13. Work Phone Number
15. Cell Phone Number
16. Email Address*
18. Emergency Contact Name
19. Emergency Contact Phone Number
20. Emergency Contact Cell Phone
24. Check all boxes that apply. If you check any of the below boxes, please list all details in the space provided below.

    1. I have cancelled my newspaper while I am gone.
    2. I have cancelled my mail while I am gone.
    3. I will be leaving lights/radio/TV on in my house.
    4. The lights/radio/TV will be on a timer.
    5. I will be leaving vehicles in my driveway.
    6. There is an alarm on my house.

    1. I am leaving dogs/pets in my house.
    2. Someone will be taking care of my pets in my absence.
    3. I have scheduled pool service.
    4. I have scheduled lawn care.
    5. I have scheduled maintenance service.
    6. I have scheduled other regular service.
26. List Rooms/Times Lights Will Be Lit
28. Describe Vehicle(s) Left in Driveway
30. Dates/Times of Scheduled Service
32. Alarm Company Name
33. Alarm Company Phone Number
35. Additional Comments
Leave This Blank:


37. 1. Receive an email copy of this form.
38. Email address

    This field is not part of the form submission.

39. Submit

* indicates a required field