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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