The personal information requested in the "Residence Information" section assists the Roswell Communication Center (911) to maintain accurate data to ensure that all Roswell emergencies are dispatched as quickly as possible.

If you have any questions regarding your Residential Security Check Request, please contact the Roswell Police Department at residentialsecuritycheck@roswellgov.com or 770-640-4100.

1

Residence Information

 *

Residence Information

Occupant Name:

Street Address:

City:

State:

Home/Cell Phoneext.

Date of Birth:

Email address:

2

Trip Information

 *

Trip Information

Departure Date:	Departure Time:
Return Date:	Return Time:

3

Additional Information

 *

Additional Information

Emergency Phone:ext.

Lights on Timer?

Alarm System?

Alarm Company

Alarm Company Phone Numberext.

Vehicle(s) Present at Residence

Vehicle(s) Location, i.e. garage, driveway, etc.

Animals Present

House Keeper, Care Taker, or Other Persons Authorized on Premises

House Key Location

4

Local Contact Information

Local Contact Information

Local Contact Name:

Street Address:

City:

State:

Zip Code:

Home/Cell Phone:ext.

5

Comments/Special Instructions

Special Instructions

1. To receive a copy of your submission, please fill out your email address below and submit.
2. Email Address

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