VACANT RESIDENCE FORM

Completing the form below will give the Rye Police Department valuable information in the event of an emergency while you are away from your residence.

Name:
Address:
E-Mail:
Home #:
Cell #:
Length of vacancy:	Short Vacation Seasonal Vacancy Long Term Vacancy
Departure date:
Return date:
Local contact name:
Local contact phone:
Is the residence alarmed?	Yes No
Will there be anyone who has permission to be in your house while you are away?	Yes No
If yes, list their names and vehicles:
Any other information you think the Rye Police should be aware of:

RYE POLICE DEPARTMENT

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VACANT RESIDENCE FORM