I, the undersigned, affirm that I am the owner/ legal occupant of the property indicated, and further agree to hold harmless the City of Verona Police Department and any of its agents or representatives, acknowledging that by completing this form and filing the same with the City of Verona Police Department, I am requesting that a record be maintained that said property will be vacant during the times listed below. I further acknowledge, the filing of this registration in no way binds or implies that the City of Verona Police Department will be responsible for the security and safekeeping of my property.
Select the starting and ending dates of your request.
(Addresses outside the City of Verona cannot be submitted to the City of Verona Police Department.)
Description of Premises
Describe locations of lights being left on within home; i.e. "upstairs bedroom, over kitchen sink," etc.
Describe make and model of vehicles in the driveway (include license plate numbers, if applicable).
Neighbor, Cleaner, Pet-Sitter, Brother, etc.
Please list and describe any other person(s) with access to premises, including names, vehicles they drive, their addresses (if known), and their phone numbers. Also indicate the reason(s) for their presence at your residence, i.e. cleaning personnel, pet sitter, etc.
Type your name into this field to indicate your signature.
This field is not part of the form submission.
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