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2. Homeowner Name*
4. Address*
5. City*
6. Zip Code*
8. Contact Phone Number*
9. Alternate Phone Number
11. Homeowner's Destination*
13. Departure Date*
    Departure Date
14. Return Date*
    Return Date
16. Neighbors Informed of Departure*

    1. Yes
    2. No
18. Person(s) with Permission to be On Property
20. Does Anyone Have a Key Other Than the Homeowner?*

    1. Yes
    2. No
22. Keyholder 1
23. Keyholder 1 Phone Number
25. Keyholder 2
26. Keyholder 2 Phone Number
28. Vehicles Parked Outside?*

    1. Yes
    2. No
29. Outside Vehicles Make/Color
31. Vehicles Parked in Garage?*

    1. Yes
    2. No
32. Garage Vehicles Make/Color
34. Are Lights on a Timer?*

    1. Yes
    2. No
35. On Time
36. Off Time
38. Pets on Property?*

    1. Yes
    2. No
39. Type of Pets
41. Newspaper Stopped?*

    1. Yes
    2. No
42. Mail Stopped?*

    1. Yes
    2. No
43. Regular Visitors to Home :

    1. Housekeeping
    2. Pet-sitter(s)
    3. Plant-waterer(s)
    4. Other
45. Surveillance Camera(s) in Use :*

    1. None / not applicable
    2. Indoor
    3. Outdoor
    4. Notification to Homeowner
46. Type of Alarm System in Use :*

    1. None / not applicable
    2. Audible
    3. Silent
    4. Notification to Homeowner
48. Will you Notify BPD upon Your Return?*

    1. Yes
    2. No
50. Additional Instructions / Notes
52. Information Consent*

    1. I consent to the City of Bluffton, Indiana storing my submitted information so they can respond to my inquiry.
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54. 1. Receive an email copy of this form.
55. Email address

    This field is not part of the form submission.

56. Submit

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