House Check - City of Belle Meade

If you live within Belle Meade City limits and you would like the Belle Meade 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. If you have any difficulties completing this form, please call 615-297-0241.

Name

Address

Date of Departure

MM slash DD slash YYYY

Date of Return

MM slash DD slash YYYY

Please call (615) 297-0241 if you return earlier than indicated.

Time of Departure

Phone #1

Phone #2

Do you have an alarm service?

Yes

Alarm Service Name

Alarm Service Phone

Are the interior lights on timers?

Yes

Are the exterior lights on timers?

Yes

Will the mail/newspapers be stopped?

Yes

Doors and windows locked?

Yes

Are there pets around the residence exterior?

Yes

Are there pets around the residence interior?

Yes

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 home?

Yes

If yes, who?

Is the home for sale?

Yes

Real estate agent name

Real estate agent number

Where can we reach you?

Does local contact have a key to residence?

Yes

Name of Local Contact

Local Contact Phone

Comments

Please read the following statement before submitting this form. The Belle Meade Police Department, per your request, will attempt to check your residence periodically. Neither the city of Belle Meade, nor the Belle Meade 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 Belle Meade or the Belle Meade Police Department assumes any liability with the "House Check Service." The resident, by accepting the "House Check Service," 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.

The Belle Meade Police Department will not consider any requests without agreement to the release provisions listed above.

58823

House Check Services

Name

Address

Date of Departure

MM slash DD slash YYYY

Date of Return

MM slash DD slash YYYY

Please call (615) 297-0241 if you return earlier than indicated.

Time of Departure

Phone #1

Phone #2

Do you have an alarm service?

Yes

Alarm Service Name

Alarm Service Phone

Are the interior lights on timers?

Yes

Are the exterior lights on timers?

Yes

Will the mail/newspapers be stopped?

Yes

Doors and windows locked?

Yes

Are there pets around the residence exterior?

Yes

Are there pets around the residence interior?

Yes

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 home?

Yes

If yes, who?

Is the home for sale?

Yes

Real estate agent name

Real estate agent number

Where can we reach you?

Does local contact have a key to residence?

Yes

Name of Local Contact

Local Contact Phone

Comments

Release Agreement:

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

The Belle Meade Police Department will not consider any requests without agreement to the release provisions listed above.

12302