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2. First Name
3. Last Name
5. Address1
7. Address2
9. City
10. State
11. Zip
13. Phone
15. Date of Absence:
17. From
18. To
20. List an emergency telephone number and address (if available) where you can be contacted in the event of an emergency:
22. Will anyone else be checking on your home?

    1. Yes
    2. No
24. If so, who?
25. Their Phone Number
27. Describe the vehicles left at the premises:
29. Describe the pets left at the premises:
31. Have lights been left on?

    1. Yes
    2. No
32. Times for Lights on Timers
34. Which part of the residence are the lights located?
36. Disclaimer
    I understand that this house watch is provided free of charge as a courtesy to the citizens of Llano. I agree that neither the Llano Police Department nor the City of Llano will not be held liable should any criminal acts or damage occur to my property during by absence.
38. Signature of Resident
39. Date
Leave This Blank:


43. 1. Receive an email copy of this form.
44. Email address

    This field is not part of the form submission.

45. Submit Submit and Print

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