Vacation Notification Form

Please be advised that by providing the following information, it will be used for Police Officer awareness only. It is not a contract or agreement by the Niskayuna Police Department to provide any special consideration or extra attention to the address provided.

If possible, it is important that you provide a phone number to reach you while you are away should we need to contact you as the homeowner.

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Please provide the following information:

First Name:*

Last Name:*

Email:*

Address:*

Phone Number:*

Date Leaving:*

Date of Return*

Key Holder:*

Phone Number of Keyholder:*

Please provide any additional information here:

Lights on Timers

Yes

No

Contractors

Yes

No

Lawn Maint. / Snow Plow

Yes

No

Alarm System

Yes

No

House Cleaner

Yes

No

<a href="http://www.niskayuna.org/departments/police/vacation_notification_form.php">Your Link Name</a>