*** Select Agency or City:
Platte County Sheriffs Office
Camden Point
Dearborn
Edgerton
Farley
Ferrelview
Houston Lake
Iatan
Kansas City
Lake Waukomis
Northmoor
Parkville
Platte City
Riverside
Tracy
Weatherby Lake
Weston
*** Your Name: Phone Number: *** Address: City: *** Zip Code: DATES MUST BE FORMATTED AS MM/DD/YYYY TIME MUST BE HH:MM WITH AM or PM ONLY *** Departure Date: *** Departure Time: *** Return Date: *** Return Time: Owner's Address: (if different than checked address): City: Name of Emergency Contact: Emergency Contact's Address: City: Zip Code: Emergency Contact Telephone Number: *** Do you have an alarm system? Yes No If yes, please provide the following: Alarm Company Name: Phone Contact: Type of alarm (i.e. motion, glass breakage, intrusion, panic, etc.) - Describe Below: Alarm Key Holder: Phone Contact: *** Have you stopped your mail? Yes No *** Have you stopped your newspaper? Yes No *** Will there be lights left on (or on timers) for security purposes? Yes No If yes, please advise where: *** Do you have pets? Yes No If YES, please advise the type and number (dogs, cats, birds, snakes, etc.): *** Will you have vehicles parked at the residence? Yes No If YES, please give a description including *** Will Anyone have permission to use the residence in your absence, includingYes No If YES, please advise who, when, relationship to resident, purpose, *** Enter your email address (REQUIRED ):
