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Home Owner's Name Title First name Last name Contact Phone Alternate Phone

Address Street City State Zip Code Email Address

Property Information

Property Details Departure Date Return Date Dog(s) ? If YES Care Giver Name and Number

Alarm System? Name and Number of Person with Access Code Type of Premises If Other, State Type:

Vehicles on Premises Vechicle 1 Make Model Plate Color

Vechicle 2 Make Model Plate Color

Vechicle 3 Make Model Plate Color

Acknowledgement

REQUESTOR'S ACKNOWLEDGEMENT I REQUEST THAT A SECURITY CHECK BE MADE OF MY PROPERTY, AND I UNDERSTAND THAT ANYONE FOUND ON THE PROPERTY IS SUBJECT TO BEING DETAINED AND INTERVIEWED BY AN OFFICER OF THE RENO POLICE DEPARTMENT. SHOULD MY PLANS CHANGE, AND I DO NOT LEAVE, I WILL NOTIFY THE RENO POLICE DEPARTMENT IMMEDIATELY SO THAT THIS SECURITY CHECK CAN BE CANCELLED.