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2. Please fill out this form and submit at least one week prior to leaving on vacation. Make sure to lock all doors and windows prior to leaving and please notify the police department when you return. If you have any questions about this form, call Police Records at (714) 990-7625.
4. Date Leaving:
5. Date Returning:
7. Name:
8. Phone #:
10. Address:
12. How can we reach you when you are gone?
13. Person(s) authorized on premises:
15. Person(s) having a key to the residence:
    *Please list their names, home phone #, and work phone #.
17. Will the lights be left on?

    1. Yes
    2. No
18. Will the lights be on a timer?

    1. Yes
    2. No
19. Will animals be left on premises?

    1. Yes
    2. No
21. Vehicles left on premises: Make / Model / Color / License # / Location
    Example: Dodge / Ram truck / Blue / 1234567 / Driveway
23. Please provide any other information you would like us to know:
Leave This Blank:


25. 1. Receive an email copy of this form.
26. Email address

    This field is not part of the form submission.

27. Submit

* indicates a required field