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2. Complete the following information and Public Safety will drive by your property while you are on vacation or when the premises is vacant.

   If you have questions, please contact the City of Ionia Department of Public Safety at 616-527-4431.

6. Contact Information

8. Contact Name*
10. Address*
12. City*
13. State*
14. Zip Code*
16. Phone Number*

    With area code. No prefixes or dashes. Example: 6165274170

17. Email Address*

    Required. We can send you dates when the premises are checked.

19. Reason for Extra Patrol*
20. Type of Premises*

    1. Business
    2. Residence
    3. Other

24. Vacation Information

26. Date Leaving*
    Date Leaving
27. Date Returning*
    Date Returning
29. Any Lights On?

    1. Yes
    2. No
30. Vehicles in Driveway?

    1. Yes
    2. No
32. Alarm System Protection?

    1. Yes
    2. No
36. Emergency Contact Name*
38. Emergency Contact Address*
40. City*
41. State*
42. Zip Code*
44. Emergency Contact Phone*
45. Does Emergency Contact Have a Key?*

    1. Yes
    2. No

49. Additional Information

51. Notes

    Anything else we should know?

Leave This Blank:


53. 1. Receive an email copy of this form.
54. Email address

    This field is not part of the form submission.

55. Submit

* indicates a required field