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Town of Cornelius
Police Department
21440 Catawba Ave
Cornelius, NC 28031
Ph: (704) 892-1363
Fx: (704) 896-0666

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Cornelius Police Department

Security Check Request

The Cornelius Police Department offers security checks to all of the citizens and businesses of the Town of Cornelius. This service is provided to residents who are going out of town and wish to have a police officer check their residence periodically while they are away, or to businesses who wish to have an officer check the business for security reasons. Please complete this form after reading the information below.

Important - Please Read


Internet Security
When submitting forms over the internet, there is always the risk that information provided can be viewed by someone else. The Cornelius Police Department takes normal precautions to protect data, and we only ask for the minimal information necessary to process your request. However, you are submitting this data with the understanding that we cannot guarantee this information will not be intercepted. You can visit or call the police department at 21440 Catawba Avenue (704) 892-1363 if you do not prefer to submit this form online.

Disclaimer
The police department makes every effort to check every security check request we have on file. However, due to our response to other calls for service, we cannot guarantee the security of your property on an individual basis. If you are going to be away, you should take every precaution to secure your property in your absence.
General Information
Last Name
 First Name
M.I.
   Day Phone
Property Address
 City
State
Zip
 Home Phone
Your Address (if different)
 City
State
Zip
 Other Phone
Email Address
Property Type?
Residence
Business		 If business please provide business name
Contact while away (if not yourself)?
 Contact's Phone Number
Contacts Address (include City, State, Zip
 Contact's 2nd Phone Number
Time Period for Security Check Request
FROM: Date
 Time

AM PM		 TO: Date
 Time

AM PM
Property Information
Please give directions to the property from Interstate 77:
Please check all of the following that may be on the property while you are away?
 A dog will be on the property   Other Animals (cats, etc)   Other Persons (list below)
Alarm system?
Yes    No 		If yes, is it monitored?
Yes    No 		Name of alarm company
Please list any other persons that are authorized to be on the premises:
Please list any vehicles that will remain on or may be visiting the property:
Please describe any lights or timers that may be left on while you are way:
Please list any other information you feel is important:


By selecting the check box below, I certify that I am the owner or caretaker of the property described above, and that the information provided is to the best of my knowledge. I further understand this information is being transmitted over the internet and could be subject to interception by third parties and could be delayed or not delivered due to techinical errors. I further understand the Cornelius Police Department cannot guarantee your property will be checked with regularlity, if at all, under this program due the possibility that higher priority requests for service could interfere.

I have read and understand this notice


Type the numbers and letters in the box (not case sensitive)
  





 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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