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Out of Town Notification

  1. Instructions
    Please complete and submit the form below. We ask for five business days notice. An officer from the Coralville Police Department will contact you to confirm we've received your request. Note: Information submitted on this form will be sent to the Coralville Police Department via email. To protect sensitive information, do not provide the following information on this form: Social Security or driver’s license numbers, bank account information, medical information, passport numbers, and passwords.
  2. Coralville Police Department seal
  3. Resident Information
  4. Is this your*
  5. Have keys been left with anyone?*
  6. Will someone be working at or have access to the premises?*
  7. Will any vehicles be left in driveway/carport?*
  8. Will any lights be left on in the premises?*
  9. Do you have an alarm?*
  10. Will any animals be left on or in the premises?*
  11. Please Review*
    Vacation security home checks will be conducted as time permits by the Coralville Police Department. By submitting this form, I release the Coralville Police Department of all liability for any loss or property damage occurring during this time period.
  12. Leave This Blank:

  13. This field is not part of the form submission.