Vacant House Card | Orchard Park, NY Police Department

Vacant House Card Form

The Vacant House Card can be completed online and submitted electronically to the Orchard Park Police Department prior to your extended absence.

Please complete the form below and hit submit. The finished form will be emailed to the Orchard Park Police Department and a copy will be emailed to the email address you enter on the form.

Occupant's Name(Required)

Address(Required)

Street Address Address Line 2 City State ZIP Code

Today's Date(Required)

Telephone(Required)

This phone is a ...(Required)

Cell

Landline

Email(Required)

Enter Email Confirm Email

Vacationing At(Required)

First day house will be vacant(Required)

Date you will be returning(Required)

Will anyone be accessing the house while vacant?(Required)

Yes

No

Name(s) and Address(es)

Keyholders

Emergency Information

Signature(Required)

Please use your mouse or your finger (on mobile devices) to sign your name

Remarks

Is there anything else we need to know?