Live work play
Full Name:
Address:
Phone:
Email:
Start Date:
End Date:
Alarm?
Intrusion?
Fire?
Keyholder Name:
Keyholder Phone:
Alarm Company Name (if Yes and no Keyholder):
Alarm Company Phone:
Interior Lights:
Exterior Lights:
Vehicle(s) on Property:
Remarks/Comments (e.g. person(s) feeding pets, doing yardwork/housework/repairs, staying in residence temporarily, additional local keyholders, etc.):
Contact Yellow Springs PD immediately upon your return to remove your name from the house check list.
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