Applications, Forms, and Permits

2. Marysville Police Division

   1250 West Fifth Street, Marysville, Ohio 43040
   Phone: 937-645-7300 / FAX: 937-645-7301 / Email: marysvillepd@marysvilleohio.org

4. The Marysville Police Division (MPD) offers this service to residents when they are away from home for an extended period of time. Officers will make a reasonable effort to check your home and property periodically through increased police patrol around your home while you are away. If police officers find your home unsecured, we will attempt to contact you or any additional person you list on the form. Please remember to contact the Police Division when you return home to end the watch service.

6. Residential Security Form*

   1. Vacation

   1. Other
7. If Other, please explain circumstances
9. Name*
10. Location Type*

    1. Residential
    2. Business
12. Watch Location/Address*
14. Home/Mobile Phone Number*
15. Emergency Contact Phone Number
17. Start Date*
    Start Date
18. Start Time
    Start Time
19. End Date*
    End Date
20. End Time
    End Time
24. Alarm System*

    1. Yes
    2. No
25. Alarm Company and Phone Number
27. Lights Activated

    1. First Floor
    2. Second Floor

    1. Kitchen
    2. Rear Outside

    1. Front Outside
    2. Living Room

    1. Bedroom
29. Lights on a Timer?*

    1. Yes
    2. No
30. Is there a paper stop?*

    1. Yes
    2. No
31. Animals Present?*

    1. Yes
    2. No
32. Cars Present?*

    1. Yes
    2. No
36. Vehicle Information (only vehicles that are expected to be at the location)
38. Make
39. Model
40. Color
41. License Plate Number
43. Make
44. Model
45. Color
46. License Plate Number
50. Local Contact/Authorized Persons (List in the order you would like us to contact)
52. 1) Name
53. Relationship
54. Key Holder

    1. Yes
    2. No
56. Address
57. Phone Number
59. 2) Name
60. Relationship
61. Key Holder

    1. Yes
    2. No
63. Address
64. Phone Number
68. Alternate Key Location
70. Submitted By*
71. Date Submitted*
    Date Submitted
73. Reminder - Please make arrangements for snow and ice removal from sidewalks while you are away. See City Ordinance 521.06 for further information.

75. Disclaimer: This service should not be considered a substitute for proper home security precautions and does not guarantee the prevention of harm or theft to your property.

Leave This Blank:


77. 1. Receive an email copy of this form.
78. Email address

    This field is not part of the form submission.

79. Submit

* indicates a required field