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2. The Palm Beach Police Department offers a FREE Closed House program to ALL Town of Palm Beach Residents.
   If you are leaving town for a weekend or an extended period of time, the Closed House program is one crime prevention tools that may be very useful in protecting your home. Please complete the form below. Be specific when providing information as this will assist our officers when performing the checks. If you have any questions regarding the program you may call the Palm Beach Police Department at (561) 838-5454 or you may visit us at any time to complete the form in person. PLEASE NOTE: You are REQUIRED to contact the Palm Beach Police Department immediately upon your return to remove your name from the list.
4. PRIVACY STATEMENT
   Information submitted using this form is sent directly to a designated person at the Palm Beach Police Department via regular email (not encrypted). The information is not maintained in a database at this website. While unlikely, it is technically possible for a third party to intercept your information. If you prefer, paper forms are available at the police department.
6. Notice: Under Florida law, e-mail addresses are public records. If you do not want your e-mail address released in response to a public records request, do not send electronic mail to this entity. Instead, contact this office by phone or in writing. Fla. Stat. 668.6076, History.-s, 1, ch. 2006-232.
8. Email*
12. First Name*
13. Last Name*
15. Local Address*
17. City
18. State
19. Zip
21. A Phone Number Where You Can Be Reached (e.g. Your Cell Phone Number). Please Include the Area Code. If In Doubt, Enter Your Home Telephone Number. *
23. Out of Town Address*
25. City*
26. State*
27. Zip*
29. Out of Town Phone: (Please Include the Area Code) *
31. Email Address*
32. Secondary Email Address
34. Date Leaving Residence*
    Date Leaving Residence
35. Date Returning*
    Date Returning

    Date Returning
37. Are Any Persons Authorized To Be On Your Property? Please Specify Name, When They Are Allowed On Your Property and What They Will Be Doing. (Landscape, Pool, Maintenance, etc.)
39. Please List Any Other Key Holder Name(s) and Phone(s).
41. Alarm Company
42. Alarm Code
44. Alarm Representative and Phone Number(s)
46. Are There Cars in Drive? Do not leave your vehicle on Town streets as it can be cited and towed for violating the Town's 48 hour parking prohibition.

    1. Yes
    2. No
47. If Yes Describe the Cars (color, make, model, license plate number).
49. Do you have a Gate Code?

    1. Yes
    2. No
50. If Yes, What is Your Gate Code?
52. Will Any Lights Be Left On or Placed On Timers in Your Home? Please Specify Which Rooms and Times.
54. Did You Stop Your Newspaper Delivery?

    1. Yes
    2. No
    3. N/A
55. Have You Arranged For Your Mail Delivery? (Will your mail be forwarded, held at the post office or will someone be picking up the mail?)

    1. Yes
    2. No
57. Comments and Miscellaneous Information
59. I understand that I must contact the Palm Beach Police Deparment immediately upon my return Palm Beach to remove my address from the Closed House Program List. (Check "YES" if you understand your obligation). *

    1. Yes
Leave This Blank:


61. 1. Receive an email copy of this form.
62. Email address

    This field is not part of the form submission.

63. Submit

* indicates a required field