2. If you have a residence in the City of St. Cloud and wish to request a vacant home check by our department please complete the following information.

   If you are NOT a resident of the City of St. Cloud, we will not be able to process this request. Please contact your local law enforcement agency for assistance.
4. 
   
6. CONTACT INFORMATION
8. First Name:*
9. Last Name:*
11. Date of Birth*
13. Address:*
15. City:*
16. State:
17. Zip:
19. If the address above is different than the location to be checked, please enter the location of the vacant home check here:
21. Phone Number:*
22. Email Address:*
24. 
    
26. VACATION INFORMATION
28. Date Leaving:*
30. Date Returning:*
32. Do you have any lights on inside the house?*

    1. Yes
    2. No
34. If yes, location of lights:
36. Do you have any automatic lights set to come on inside or outside the house?*

    1. Yes
    2. No
38. If yes, location of lights and time lights are set to go on and off:
40. Any vehicles in the driveway or in the garage?*

    1. Yes
    2. No
42. If yes, give vehicle descriptions and license plates:
44. Have you stopped delivery of your mail and/or newspaper?*

    1. Yes
    2. No
46. Will anyone be taking care of yard work (i.e. mowing, snow removal, etc.)?*

    1. Yes
    2. No
48. 
    
50. LOCAL CONTACT PERSON/KEYHOLDER INFORMATION
52. Name:*
54. Address:*
56. Phone Number:*
58. 
    
60. OTHER INFORMATION
Leave This Blank:


62. Submit

* indicates a required field