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Contact Information:
Eden Police Department
2795 East Church Street
Eden, New York 14057

(716) 992-9211
(716) 992-2242 (Fax)

Police Chief
Nicholas Blasz

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Request a Premises Check

Request a Premises Check

Name *

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Last *

Last

Address *

Address

Address

Address

City

City

State/Province

State/Province

Zip/Postal

Zip/Postal

Phone *

Email *

Departure Date *

Return Date *

Key Holder

Name *

First

Last *

Last

Address *

Address

Address

Address

City

City

State/Province

State/Province

Zip/Postal

Zip/Postal

Phone *

Emergency Contact

Name *

First

Last *

Last

Address *

Address

Address

Address

City

City

State/Province

State/Province

Zip/Postal

Zip/Postal

Phone *

Security Alarm Information

Do you have a security alarm? *

Yes

No

Additional Information

Are you leaving any lights on? *

No lights will be left on.

The lights will be on a timer.

The lights will always be on.

Animals left on premises? *

Yes

No

Vehicle left on premises? *

Yes

No

Are you turning your utilities off?

Yes

No

Mail: *

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It is being picked up by someone.

Paper: *

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Reason for Premises Check *

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