SUSSEX PUBLIC SAFETY

police@sussexwi.gov

N64W24335 Main Street
Sussex, WI 53089

262-246-5237

Extra Patrol/Vacation Check Form

Contact Phone Number

Vacation Start Date

Vacation End Date

Lights On? Check all that apply

Kitchen

Living Rm

Bed Rm

Family Rm

Outside

Light Timer?

YES

Where and when will timers be on?

Vehicles on Premises?

YES

Vehicle Information and Location

Key Holder Information

Name

Phone Number

Additional Information

All forms should be received at least 48 hours before vacation date.

Any questions or concerns contact Sussex Public Safety Monday - Friday 8am-5pm. 262-246-5237