City of Cerritos Community Safety Division (562) 916-1266 Vacation Security Check Request Form The Cerritos Sheriff's Station/Community Safety Center offers free vacation security checks for residents. While you're away, a Volunteer on Patrol will check your home for broken windows, open doors or other suspicious clues. Please submit this form at least 5 working days in advance of leaving on vacation. All information on the form must be completed in order for your request to be processed. If it is less than 5 working days from when you will leave, please call (562) 916-1266 to submit a vacation security check request by phone. Be sure to lock all doors and windows. Please notify the Community Safety Division at (562) 916-1266 if you return before your indicated return date. Type of Request What type of security check are you requesting? Vacation Fumigation Construction Security Check Dates and Times Date Leaving Month MM January February March April May June July August September October November December Day DD 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Year YYYY 2021 Start Time Date Returning Month MM January February March April May June July August September October November December Day DD 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Year YYYY 2021 End Time Your Contact Info Full Name First Name Last Name Full Address Street Address City State Choose State Alabama Alaska American Samoa Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Federated States Of Micronesia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Marshall Islands Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Mariana Islands Ohio Oklahoma Oregon Palau Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming Zip Work Phone Number Cell Phone Number E-mail Emergency Contact Information Would you like to list an emergency contact person? Yes No Will there be, for any reason, anyone visiting or staying at your property during the request period? Yes No Alarm Company Is your property alarmed? Yes No Lights and Surroundings Will the lights be left on? Yes No Will the lights be on a timer? Yes No Will access to the backyard be locked? Yes No Vehicles Number of vehicles left at location that can be seen from the street: Choose One 0 1 2 3 If you indicated any vehicles, please fill in the information for each below and/or proceed to "Pets, Deliveries and Other Services." Vehicle Number 1 Make Model Year Color License Plate Number Vehicle Number 2 Make Model Year Color License Plate Number Vehicle Number 3 Make Model Year Color License Plate Number Pets, Deliveries and Other Services Do you have a dog in the backyard? Yes No Have you stopped newspaper/mail delivery? Yes No Is someone retrieving newspapers/mail for you? Yes No Does a lawn service maintain your property? Yes No Do you have a pool service? Yes No Details Please type any other information you want us to know. (Please limit your message to 1,000 characters or less.) Details Having reCaptcha issues? Click here to reset the widget. Meddon