Housewatch Request Form - Town Of Ashby Police Department
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1Town of Ashby
Phone: (978) 386-5652
Police Department
Fax: (978) 386-7753
893 Main Street, PO Box 280
Website:
Ashby, MA 01431
E-Mail: info@ashbyma.gov
____________________________________________________________________________________________________________________________________________________________
HOUSEWATCH REQUEST FORM
NOTICE:
Housewatch requests are valid for 14 days. To continue beyond 14 days, the requestor must call the
Police Station and renew it using the assigned ID#. The requestor must call the Police Department on the date of
return to close the Housewatch. Housewatch forms must be dropped off at the police station.
Date Filed: ___________
ID#: _________________
(Assigned by Police Dept.)
Property Address: ____________________________________________________________ Ashby, MA 01431
Phone # at Address: _______________________________
E-Mail: ____________________________________
Requestor’s Name: ________________________________
Requestor’s Signature: ________________________
Departure Date: __________________________________
Return Date: ________________________________
Emergency Contact Name: ________________________________________
Phone #s: ____________________
Emergency Contact Name: ________________________________________
Phone #s: ____________________
Who is authorized to be in the house or on the property? ________________________________________________
What type of vehicle do they drive? ________________________________________________________________
Do they have keys to the house?
[
] Yes
[
] No
Do they have Alarm Codes?
[
] Yes
[
] No
Will anyone, at any time, stay overnight at the property?
[
] Yes
[
] No
(For each person, provide name so we can positively identify them)
_________________________________________________________
________________________________________________________
_________________________________________________________
________________________________________________________
_________________________________________________________
________________________________________________________
If you have an Alarm, list the Alarm Company and Contact Information:
____________________________________________
_____________________________________________
What vehicles will be left at the property? ________________, ________________, _______________
(Year/Make)
(Year/Make)
(Year/Make)
Will there be any pets left at the property? [
] Yes
[
] No
(If so, please list the name(s) of the person tending to pets)
_________________________________________________________
________________________________________________________
_________________________________________________________
________________________________________________________
Additional Comments:
____________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________
(For Police Use ONLY): PAMET Date: ___/___/___, Rec’d By: ______________________________, End Date: ___/___/___
Renewal Dates: ___/___/___,
___/___/___,
___/___/___
Version: 12/17/2013
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