Independence, Kentucky Police
Vacation Check Request Form
   If you are going on vacation and would like the Independence Police Department to monitor your home or business for activity or emergencies please fill out the form below as complete as possible.
This form is required to be filled out 5 business days before you leave for vacation. If you cannot fill it out 5 days prior or leave in an emergency please call (859) 356-3191 and ask to speak to an officer to be added to the vacation list.
* denotes a required field.

Home owner's full name: *
Address of property *
Apartment, Suite, or Condo #
Your home phone number: *
Your cell phone number (with area code)
Your e-mail: *
Date Leaving *
Date Returning *
Your IP Address:

List up to 3 persons to contact in case of an emergency

Name & Relation
Address
Phone Number
1
2
3

Alarm System:
Yes  No 
Type of alarm:
Burgler  Panic  Fire 
Alarm is:
Silent  Audible 
Alarm Company:
 
Alarm Company Telephone:

If there is any after hour lighting please describe and be as specific as possible:
All other information including friends or relatives checking the house, feeding pets, collecting mail or newspapers, and etc.


Independence Police

5409 Madison Pike
Independence, Ky. 41051
phone: (859) 356-2697
fax: (859) 363-4840

Independence Police Directory
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V.I.P.S. Program Handbook
V.I.P.S. Program Application

Online Police Forms
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Information Contact Form
Recognize an officer for
a job well done
Request a Radar Trailer
Vacation Check Form

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