House Check Form

Mansfield Division of Police

Home Security Check

Name*     Address*           Phone#*     Subdivision      
Departure Date*           Departure Time   Return Date* Return Time      

Please notify Mansfield Division of Police immediately upon return.

The Mansfield Police Auxiliary provide this service free of charge in an attempt to better serve the citizens of Mansfield. Availing yourself of this service carries no guarantees, implied or actual. Checks are performed randomly.

Where You May Be Reached:    
Person With Keys? Yes No      
Keyholder Name           Keyholder Address   Keyholder Phone#        


Vehicles at Residence?   Yes No    
Make Model YR License #
Make Model YR License #
Alarm System? Yes No Auto Reset? Yes No  
Alarm Company:  
Person Authorized to Re-Set Alarm:      
Animal on Premises? Yes No    
Names, Kind, Location:  
Name of Persons Having Permission to Be in Your Residence:
Name of Persons Working on Your Property:
Lights Left On? Yes No  
Timer On? Yes No  
Additional Information
Required Fields *