E-Gov Services Goshen Township

WARNING! Please do not use this form to report issues of an emergency nature or for conditions requiring an immediate response. If your issue is an emergency, please use the telephone and dial 911.

Vacation House Check Request Form

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Purpose. This form is used to communicate with the police department if you wish to schedule a house check while you are on vacation.

* Information is required.

Contact Information

* First Name:
* Last Name:
* Email:
* Daytime Phone:	() –
* Address:
* City:
* State:
* ZIP:

* What date are you departing?

* What date are you returning?

* Is your home protected by a security system?

Yes

* Will you be leaving any lights on, and if so, are they on constant, on a timer, or other automated device?

* Are you leaving keys to your home with anyone locally? If so, that person�s name address and telephone number;

Will the key holder know how to reach you in the event of an emergency to your property?

Yes

* Are there any parties that have permission to be on your property during your absence?

* Description and plate number of any vehicles left on your property during your absence.

Check here to have email confirmation of this submission.

* Information is required.

Notes:

If you send us a message, you will receive a Tracking Number allowing you to follow-up with your request, at your convenience.

Internal Use Only, Leave Blank:
Please leave this field blank and remove any values that have been populated for it.