Property Owner Information Form

	Emergency Notification Program
	*This program is a courtesy extended to all property owners by the Lavallette Police Department.* Please Check One: New Information Update Information Lavallette Property Information: First Name: Last Name: Address: Apt Lavallette Phone Number: Cell Phone Number: Email Address: Work Phone Number: Ext: Type of Heat: Alarm: Alarm Company: Phone: Occupancy: Invalid or Bedridden person in the home: Home Address Information Same as above (If different, fill out information below) Address: Apt City: State: Zip: Phone Number: Emergency Contact Information (other than the homeowner) Contact 1: Phone: Contact 2: Phone: Company or Person Authorized to Make Repairs Repair Contact 1: Phone: Repair Contact 2: Phone: Also available in PDF form to mail or drop off at Police Station Visit Forms Page *Please Note that the Lavallette Police Department must be able to make immediate contact with either the homeowner or authorized contact person in case of an emergency.*

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