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2. RESIDENTIAL CHECKS
   The Powder Springs Police Department provides residential property checks. If you will be traveling or away from your home for an extended period of time, sign up and request that the Powder Springs Police Department check on your residential property. If you have questions about residential checks, please contact Maj. Dwayne Prosser at 770-943-1616 or dprosser@cityofpowdersprings.org
4. First Name*
5. Last Name*
6. Phone #*
8. Address1*
10. Address2
12. City*
13. State*
14. Zip*
16. NOTICE
    Please contact the police department if your leave time is more than two weeks.
17. Starting Date*
    Starting Date

    Starting Date
18. Ending Date*
    Ending Date

    Ending Date
20. Alarm*
    -- Select One --YesNo

    Will you have an active alarm?
21. Pets*
    -- Select One --YesNo

    Will you have pets in the residence?
22. Outside Lighting*
    -- Select One --YesNo

    Will you have outside lighting on a timer?
23. Interior Lighting*
    -- Select One --YesNo

    Will you have interior lighting on a timer?
25. Keyholders*
    -- Select One --YesNo

    Are you leaving residence key(s) will a relative or neighbor?
26. Keyholder's Name
27. Keyholder's Phone #
29. Emergency Contact Name*
30. Emergency Contact Phone #*
32. Please provide any additional information, such as vehicles or persons that are approved to be at the residence in your absence.
Leave This Blank:


34. 1. Receive an email copy of this form.
35. Email address

    This field is not part of the form submission.

36. Submit Submit and Print

* indicates a required field