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Sheriff's Vacation Home Check

1. Step One This section is complete This section is incomplete
2. Residence Information This section is complete This section is incomplete
3. Absence Information This section is complete This section is incomplete
4. Emergency Contact Information This section is complete This section is incomplete

Thank you for completing the PCSO Vacation Home Check request form. The information here will be used to create your vacation home check. Please make sure all of the information is complete and accurate. One of our staff members will contact you to confirm receipt of this information.
VHC #:
PCSO front office staff, enter the PC number for this VHC into this field once submitted.
CONTACT INFORMATION
Please provide the contact information for the person submitting the form. Questions will be directed to this person.
First Name*
Last Name*
Home Phone*
Cell Phone*
Email Address*
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RESIDENCE INFORMATION
Please provide us with the physical address of the residence at which you are requesting a vacation home check.
Address1*
Address2
City*
State*
Zip*
Directions To Residence
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ABSENCE INFORMATION
Please complete the information below regarding your absence.
Leave Date*
Leave Date
Return Date*
Return Date
Alarm System At Residence?*
Night/Exterior Lights At Residence?*
Is anyone allowed at the residence while you're away? (e.g. plumber, property manager)*
If "Yes", please list the first/last name of the people that have permission to be at your residence while you are away.
First Name
Last Name
First Name
Last Name
First Name
Last Name
Will there be vehicles left at the residence while you are away?*
If "Yes" please list the vehicles that have permission to be at your residence while you are away.
Vehicle Make
(Chevrolet, Porsche etc.)
Vehicle Model
License Plate #
Vehicle Make
Vehicle Model
License Plate #
Newspaper Delivery?
US Mail Delivery?
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EMERGENCY CONTACT INFORMATION
Please provide at least ONE emergency contact for the residence.
First Name*
Last Name*
Emergency Contact Phone*
Does this person have keys to the residence?*
Additional Notes
If there is anything else you want the deputies to know about your residence while you are gone, please indicate that above.
AUTHORIZATION*
By selecting "I AGREE" you are indicating that you are authorized to request the Pitkin County Sheriff's to perform vacation home checks at the address listed above. Although no amount of crime prevention can guarantee a burglar will not strike, the Sheriff's Office believes that this increased patrol will deter the potential criminal.

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