Dwellings Temporarily Vacant Form

I understand that I am notifying the Salisbury Police Department that my residence will be unoccupied for the time listed below and that the Salisbury Police Department assumes NO LIABILITY for any damage incurred during my absence. I further understand that the checks of my residence may only be made as time and workloads allow.

Dwellings Temporarily Vacant

Please check below to show you have read and agree with above disclaimer*
- Agree
Date Vacant*
Enter the date Dwelling will be vacated
MM slash DD slash YYYY
Return Date*
Enter the date you plan to return to this Dwelling
MM slash DD slash YYYY
Owner Name*
First Last
Address
Pleased enter Address of Vacant Dwelling

Street Address Address Line 2 ZIP / Postal Code
Phone*
Enter phone number where you can be reached
Email*
Remarks
Please enter any remarks, such as allowed cars in driveway, lights on timers, persons authorized to enter etc
Key Holder or Local Person To Contact?
Enter name and Phone of Local Person to Contact if needed
First Last
Phone