2. The Byrnes Mill Police Department Extra Patrol/Vacation Watch Form will help us to provide extra patrol to the area of your business/residence in your absence. Please note that the Byrnes Mill Police Department is not responsible for the safety of your home, offering this service as a courtesy and cannot guarantee availability of officers. Should a problem require urgent attention, please call us immediately. For a police emergency, dial 911. Otherwise, call (636) 677-7727 fax (636) 677-5533.
   
   
4. Byrnes Mill Police Department
   141 Osage Executive Circle Byrnes Mill, MO 63051
6. First Name*
7. Last Name*
9. Name of Subdivision; if applicable
11. Street Number*
12. Street Name*
13. Apt #
15. Email*
16. Phone Number*
18. Reason for extra patrol:*

    1. Vacation
    2. Premises will be vacant
    3. Other (please explain)
19. Other (explained):
21. Type of premises:*

    1. Residence
    2. Business
    3. Other (please explain)
22. Other (explained):
24. Protected by alarm system:*

    1. Yes
    2. No
25. If yes, type of alarm:
27. Lights left on:*

    1. Yes
    2. No
    3. Constant
    4. Timer
29. Keys left with anyone:*

    1. Yes
    2. No
30. If yes, please include name, address and phone number:
32. Will there any cars in the driveway or garage?*

    1. Yes
    2. No
33. If yes, description of vehicle(s) and location on the property:
35. In case of emergency, who should be notified?*
    Name and phone number of person(s) who should be notified.
37. Other person(s) that will have access or are allowed on the property:
    Include name, address and phone number
39. Additional Information or Special Instructions for Officers
    If there is any additional information you wish to inform the officers about please list it here.
41. I request that a security check be made of my premises from *
    I request that a security check be made of my premises from Start Date

    —

    I request that a security check be made of my premises from End Date
43. Signed*
    By filling your name in the space above, you acknowledge that this form was submitted to the Byrnes Mill Police Department.
44. Date of request:*
    Date of request:
    Date form was submitted
Leave This Blank:


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

    This field is not part of the form submission.

48. Submit Submit and Print

* indicates a required field