MUNICIPALITY OF NEW LEBANON VACATION HOUSE CHECK

 ADDRESS:      

 NAME:      

 Telephone #:      

 DATE LEAVING:      

 DATE RETURNING:      

 PHONE # YOU CAN BE REACHED AT:     

 LOCAL EMERGENCY CONTACT

NAME:      

 ADDRESS:      

 TELEPHONE #:      

 CELL PHONE#:      

 DOES CONTACT HAVE KEY?    YES     NO

 WILL LIGHTS BE LEFT ON IN THE HOUSE: OUTSIDE: FRONTREAR

 INSIDE: LIVINGROOMBEDROOMFAMILYROOMOTHER

 WILL LIGHTS BE ON TIMER?      

 WILL ANYONE BE IN AND OUT OF HOUSE

NAME:     VEHICLE:     

VEHICLES AT RESIDENCE: MAKE:      

 

 

 

 PRINT AND TURN IN AT VILLAGE OFFICES

New Lebanon Police DepartmentEmergency Call 9-1-1

198 S. Clayton Road
New Lebanon Ohio 45345

Dispatch 687-3080 
Village Office 687-1341
Montgomery County Municipal Court Western Division 
687-9099
 
Please record your serial numbers help us be able to help you.