Printable blank form - Porterville Police Department

PORTERVILLE POLICE DEPARTMENT REQUEST FOR EXTRA PATROL
This form is to be used to request extra patrol service by the Porterville Police Department. This form
can also be used to request extra patrol at your residence or business while you are on vacation or
otherwise. Please enter all the applicable information. An item marked in red is required information
so we may properly assist you. When you have completed the form, please mail or deliver it to the
Porterville Police Department at 350 North D Street. All information supplied is subject to verification
and will be kept confidential.
If you are reporting Criminal or Suspicious Activity, please include an address or approximate location
of the activity in the Description / Explanation box. If the activity is in progress, please call (559) 782-
7400 or 9-1-1 if needed, so we can respond as soon as possible.
#1 Reason for this request
(Check one)
#2 Description/Explanation
(Location for Extra Patrol)
Criminal/Suspicious Activity in Area (Complete #2)
Vacation Checks (Complete #3))
Other (Complete #2)
Your Name
Your Phone Number
Your E-mail Address
#3 Vacation Checks
Your Name
(Optional)
(Optional)
(Optional)
Your Address
Your Phone Number
Your E-mail Address
Dates & Times you will be away
(Optional)
24 hour phone number where you can
be reached while you are away
Name/phone number of person with
key and/or alarm code (if applicable)
Page 1 of 2

PORTERVILLE POLICE DEPARTMENT REQUEST FOR EXTRA PATROL
List/describe your vehicle(s) that
will be left outside at the location (Ex:
My red ford pickup is in the driveway;
License # *******
List name/relationship/vehicle
description of each person given
permission by you to be in/at the
location while you are away.
(Ex: Fred Jones; gardener; green truck)
Please check all boxes that apply.
This location is a Residence.
This location is a Business.
I have an alarm system installed and operating properly.
There will be a dog(s) outside during my absence.
There will be a dog(s) inside during my absence.
There will be lights left on inside/outside during my absence.
There be vehicle(s) left outside during my absence.
I have notified my newspaper carrier to hold deliveries.
I have notified the post office to hold my mail.
Page 2 of 2