350 Tenny Street | Bloomsburg, PA 17815-3251
Business hours: 8 a.m. - 5 p.m., Monday - Friday
Phone: 570-784-9114
Fax: 570-387-8748
Scott Township
HOUSE WATCH FORM

    Name:

    Address:

    Phone:

    Date Leaving: Date Returning:



    Will any person(s) be in and/or around house while you are away?
    Yes No   If yes, when? / Who? (list names)

    Name: Name:
    Phone: Phone:

    Person(s) to notify in case of an emergency?
    Name: Address: Phone:

    Your destination phone number:

    Person(s) who have keys:
    Name: Name:
    Phone: Phone:

    Will any lights be left on? Yes No
    Where: When:
    Where: When:

    Other Comments: