West Branch Police Department Security/Vacation Check

Please complete the below information and click the submit button and print a copy for your records. Upon your return, please contact the West Branch Police Department so they can take your residence/business off their check list. For more information, please call Police Chief David Bloem at 643-2222 or email.

Name:
Address:
Request Made By:
Home Phone:
Cell Phone:
E-mail address:
Reason for extra patrol:	Premise will be vacant Vacation Other
If other, please explain
Type of Premise:
Protected by alarm system?	yes no
If yes, type of alarm
Will lights be left on?	yes no
If yes, are lights on:	timer motion constant
Name of person with key to residence:
Address:
Key Holder Phone Number:
Specify dates for security check:
Please remember to notify the West Branch Police Department upon your return.