662-429-9096 fax 662-449-3350
HOUSE WATCH FORM
Please submit this form to the Hernando Police
Department at least one week prior to leaving residence.
Name of Homeowner: ____________________________________________________
Address of Residence: _____________________________________________________
Phone Numbers: home __________________ cell _______________________
Email Address: __________________________________________________________
Leave Date: ________________________ Return Date: ______________________
Destination: _____________________________________________________________
Direction of Travel: _______________________________________________________
Form of Transportation (if taking personal vehicle, give description and tag number):
________________________________________________________________________
Any Animals left on site and where they will be left: ____________________________
Explain in detail any damage to property that exists, if lights will be left on, any vehicles that will remain on site, etc.
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If anyone has permission to be to as residence, give full name, description of vehicle and the purpose of them being on site.
________________________________________________________________________
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Give alarm company name, phone number and a local emergency contact name and phone number they can be reached 24 hours a day. Please make sure the person you are giving as emergency contact has a key to the residence so the premises can be checked thoroughly in case of alarm.
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- Please mail or take this form to the Police Department, attn to Jeny Black.
- Upon receipt of this form, you will be contacted to verify all information.