Webster House Check Request

2. NOTE: The purpose of reporting a house check with the Webster Police Department is two-fold.
   1. By completing this report, the police department will have a telephone number to contact you in case of emergency.
   
   2. If there is a problem in your neighborhood, the police department can check your house to make sure it is secure.

   The Webster Police Department does not physically check each residence while the homeowner is away, but uses the house check as a tool if the need arises. In addtion, only residents residing within the Town or Village of Webster may use this form.

   If you do not wish to use this online form to complete your housecheck, feel free to CLICK HERE to download and print the form in PDF format. (Adobe Acrobat Reader® required). You may fax the completed form to
   (585)872-7010 or deliver it to the police department. Our address is 1000 Ridge Road, Webster, NY 14580

4. 
   

6. First name*

7. Last Name*

9. Street Address*

11. City*

12. ST

13. Zip Code*

15. Date leaving*

16. Date Returning*

18. Home Phone*

19. Contact Phone

21. Where will you be staying and is there a phone number other than your contact number to contact you if needed?

23. Have you left your house keys with a neighbor or relative?*
    -- Select One --YesNo

25. If yes, who is the key holder?

27. Key Holders phone number

29. Are your neighbors aware that you will be away?*
    -- Select One --YesNo

31. Have you left any lights on in the house?
    -- Select One --YesNo

33. Which lights have you left on?

35. If you have left any vehicles at home please list the License Plate Number, Make, Model and color of the vehicle(s).

37. Have you left any firearms in the house?
    -- Select One --YesNo

39. Where are the firearms located in the house?

41. Has the mail been stopped?
    -- Select One --YesNo

42. Has the paper been stopped?
    -- Select One --YesNo

43. Is the house alarmed?
    -- Select One --YesNo

45. Additional Comments

Leave This Blank:


47. 1. Receive an email copy of this form.
48. Email address

    This field is not part of the form submission.

49. Submit

* indicates a required field