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2. I understand that by completing this form I am agreeing to allow officers of the Anacortes PD, as well as members of the Citizens Auxiliary Patrol, to perform physical checks on the property that I have listed. I understand that these checks may include checking windows and doors to make certain they are secured and may include walking around any structures that are on the property. I understand that property checks will not be done in inaccessible areas beyond fences or gates. I also understand that neither the City of Anacortes nor the Citizens Auxiliary Patrol assume any liability for the listed property. This form does not imply that any property checks will be performed.
   Property Checks will be performed for a maximum of 150 days and not on homes that are for sale.
4. Date
   Date
6. First Name
7. Last Name
9. Address
11. City
12. State
13. Zip Code
15. Phone Number
16. Alternate Phone Number
18. Email Address
20. House Color
21. Nearest Cross Street
23. Persons with access to my property while I am away, including phone number (neighbors, gardeners, etc.)
25. The following vehicles will be left on the property while I am away
    Provide make, model, and license plate number
27. Garage
29. Driveway
31. Street
33. A spare key will be left with
35. First Name
36. Last Name
38. Address
40. City
41. State
42. Zip Code
44. Phone Number
46. Is your property alarmed?

    1. Yes
    2. No
47. Alarm Company
49. Will any lights be on?

    1. Yes
    2. No
50. If lights will be left on, provide time and location
52. Address is posted on

    1. Curb
    2. House
    3. Mailbox
54. Please check listed property from
    Please check listed property from Start Date

    Please check listed property from Start Time

    —

    Please check listed property from End Date

    Please check listed property from End Time
56. Upon return to Anacortes, please remember to call 360-293-4684 and let us know you have returned.
Leave This Blank:


59. 1. Receive an email copy of this form.
60. Email address

    This field is not part of the form submission.

61. Submit

* indicates a required field