Piedmont Police Department
403 Highland Avenue
Piedmont, CA 94611
(510) 420-3000
FAX (510) 420-1220
Address
Resident’s Name
Date/Time Leaving
Date/Time Returning
PLEASE NOTIFY PPD UPON YOUR RETURN
Home Phone
Alternate Phone
How can we reach you while you are away?
In Case of Emergency Please Notify:
Do they have a key? YES NO
Name
Phone
Address
City
Newspaper/Mail Collected?
YES NO
Pet(s) on premises?
YES NO
Lights? YES NO Timer
Time lights on:
Time lights off:
Alarm? YES NO Silent Audible
Alarm Company:
Person(s) Authorized to be on premises:
Name
Relationship/Job:
Phone
How often on premises?
Name
Relationship/Job:
Phone
How often on premises?
Name
Relationship/Job:
Phone
How often on premises?
Other Information:
PPD USE ONLY
ACCEPTED BY:
Date Rcvd Dispatcher CAD Entry End Date Remarks
         
         

Return completed form via email at vacationchecks@piedmont.ca.gov or fax to (510) 420-1220. You can also drop completed form at the front desk of the police department which is located at 403 Highland Avenue, Piedmont.

If you have any questions, please call (510) 420-3000.

1 Does not guarantee the frequency of checks or the safety/security of your home during your absence.

2 No physical check desired, or vacancy is in excess of 30 days. THERE WILL BE NO PHYSICAL CHECK.