CPD-86

CLINTON POLICE DEPARTMENT – VACANT PROPERTY CHECK

EVENT #:__________                                                                                             SECTOR #:__________

NAME:__________________________________________________________ PHONE #:___________

ADDRESS:_______________________________________________________APT. #:______________

DATE VACANT:__________________________RETURN DATE:______________________________

LIGHTS (Y/N):______LIGHTS ON TIMER (Y/N):___________________________________________

ALARMED (Y/N):_____NAME OF ALARM SERVICE:______________________________________

VEHICLE(S) AT RESIDENCE (Y/N):_____

EMERGENCY CONTACT(S) OR ANYONE ELSE WHO MAY BE CHECKING PROPERTY:

NAME:_________________________________     NAME:_____________________________________

ADDRESS:______________________________     ADDRESS:__________________________________

PHONE #:_______________________________     PHONE: #:__________________________________

WAIVER OF LIABILITY

DISCLAIMER:  THIS PROPERTY CHECK IS PROVIDED AS A PUBLIC SERVICE AND THE CLINTON POLICE DEPARTMENT ASSUMES NO OBLIGATION TO CHECK YOUR HOME/BUSINESS DURING THE DURATION OF YOUR ABSENCE.  IF TIME AND OPPORTUNITY PERMITS, OUR PATROLS WILL ATTEMPT TO MANUALLY OR VISUALLY PROVIDE THIS FUNCTION.  WE CANNOT GUARANTEE PREVENTION OF ILLEGAL ACTIVITY OR OTHER HAZARDOUS CONDITION.  SHOULD IT BE DISCOVERED THAT THERE IS EVIDENCE OF A CRIME OR DANGEROUS SITUATION, WE WILL MAKE ALL REASONABLE EFFORTS TO CONTACT THE OWNER OR DESIGNATED RESPONSIBLE PARTIES.

I UNDERSTAND AND AGREE TO THIS WAIVER OF LIABILITY.

SIGNED:_____________________________________________DATE:___________________________

                OWNER OR PERSON OF AUTHORITY

CANCELLED BY______________________________________DATE:___________________________

COUNT  DATE  TIME  OFFICER                                                   COUNT  DATE  TIME  OFFICER

01 ___________________________________                           06 _________________________________

02 ___________________________________                           07 _________________________________

03 ___________________________________                           08 _________________________________

04 ___________________________________                           09 _________________________________

05 ___________________________________                           10 _________________________________

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