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2. Zionsville Police Department Security Check Request
4. This form is used to alert the Zionsville Police Department and the Boone County Central Dispatch of your absence from your property for a period of time.
6. First name:*
7. Last name:*
9. Address:*
11. City:*
12. State:*
13. Zip Code:*
15. Phone Number:*
17. Email Address:*
19. Destination:*
20. Departure date:*
    Departure date:

    Departure date:
21. Return date:*
    Return date:

    Return date:
23. Probable route of trip:
25. Type of premises:*

    1. Residence
    2. Business
    3. Other
27. If other, please explain:
29. Have keys been left with anyone?

    1. Yes
    2. No
30. If yes, please list the person's name and phone number:
32. In case of an emergency, do you wish to be notified?

    1. Yes
    2. No
34. Emergency contact name and phone number:
36. Lights left on (if any) and location:
38. Lights on timer?

    1. Yes
    2. No
39. If lights are on timer, time on?
    If lights are on timer, time on?

    If lights are on timer, time on?
40. If lights are on timer, time off?
    If lights are on timer, time off?

    If lights are on timer, time off?
42. Alarm on premises?

    1. Yes
    2. No
43. If yes, type of alarm?

    1. Audible
    2. Silent
44. Rings to:

    1. Alarm Company
    2. Police
46. Cars or other vehicles to be left at the premises:

    1. Yes
    2. No
48. Make
49. Model:
50. Color:
51. License Plate Number:
53. Make:
54. Model:
55. Color:
56. License Plate Number:
58. Make:
59. Model:
60. Color:
61. License Plate Number:
63. Additional information:
65. By typing my name in the box below, I certify the above information to be true and correct, to the best of my knowledge, and that this information can be used to process my request.*
Leave This Blank:


67. 1. Receive an email copy of this form.
68. Email address

    This field is not part of the form submission.

69. Submit

* indicates a required field