| Winterville Police Department P.O. Box 1459 2593 N. Railroad St. Winterville, NC 28590 Ph (252)-756-1105 Fax (252)-756-3458 Special Patrol Request |
| Address:___________________________________________________________________________________ Name:_________________________________________________________Phone:_______________________ Alarm System: Yes___No___ If yes, type of alarm: Front Door:__________ Windows:___________ Audible:____________ Lights left on Interior:__________________ Lights left on outside:_________________Automatic: Yes___No___ Describe cars left on property outside:_______________________________________________________ Name & phone number of local contact:___________________________________________ Number where you can be reached: (emergency only)_______________________________________________ Departing date/time:_________________________ Returning date/time:______________________________ Printed name and signature of person requesting:_________________________________________________ Date:_________________________ --------------------------------------------------------------------------------------------------------------------------------- Patrol Request Log Date:______________Time:_________Officer Name:________________________Remarks:_________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ |
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| In order to ensure prompt service, please print out this form and leave it at the Police Department or fax it to us during normal business hours. Thank you. |
| Vacation house checks will be conducted for no more than two weeks unless specifically approved by the Chief of Police. |