Vacation Check Request – City of Chenoa IL

If you live within the Chenoa or Gridley Town limits and you would like the Chenoa Police Department to conduct routine security checks of your residence while you are away for an extended period of time, please notify the department by submitting the following form. Homes for sale will only be checked if someone still lives in the residence.

It may take up to 48 hours to process this request. If you have any difficulties in completing this form or question if it was submitted properly, please call (815) 945-7627 to have department staff complete a request for you.

Departure and Return

Departure Date *

Time of Departure *

Return Date *

Estimated Time of Return *

Full Address of Property *

Name and Contact Information

Name *

First

Last *

Last

Email *

Phone Number *

Mobile Phone (You Can Be Reached At While Away) *

Alarm Information

Do you have an alarm service? *

Yes

No

Alarm Service Company Name and Phone Number

Details While Away

Will lights be on? *

No

Yes - Interior

Yes - Exterior

Are the lights on timers? *

No

Yes - Interior on Timers

Yes - Exterior on Timers

Will the mail/newspapers be stopped? *

No

Yes - Mail

Yes - Newspapers

Doors and windows locked? *

Yes

No

Are there pets around the residence? *

No

Yes - Interior

Yes - Exterior

Describe any vehicles on the outside of the property. Include make, model, color, and registration if possible. Indicate if the vehicle will be concealed in a garage. *

Will anyone be around the residence? *

Yes

No

If yes, who? (Name and Phone)

Is the residence for sale? *

Yes

No

If yes, what is the name and phone number of the Real Estate Agent?

Do any local contacts have key access to the residence? *

Yes

No

If yes, provide name and phone number of local contact.

Anything else we need to know

Please read the following statement before submitting this form.

The Chenoa Police Department, per your request, will attempt to check your residence periodically. Neither the City of Chenoa, nor the Chenoa Police Department assume any liability in the event of theft, loss or damage to personal or real property in or around your residence.

By submitting this form, it is understood and agreed that neither the City of Chenoa or the Chenoa Police Department assumes any liability with the "Vacation House Check." The resident, by accepting the "Vacation House Check," and by execution of this request understands and agrees to the provisions of this release.

Release Agreement *

I have read and understood the release and agree to its provisions.

I DO NOT agree to the provisions of the release.

ELECTRONIC SIGNATURE (TYPE FULL LEGAL NAME INCLUDING FIRST AND LAST) *

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