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LIGONIER VALLEY POLICE

1 Municipal Park Drive

Ligonier, PA. 15658

724-238-5105

EMERGENCIES DIAL 911

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Family Vacation

Vacation Check Request

Departure Date*

Month

Day

Year

Return Date*

Requestor's First Name*

Requestor's Last Name

Address

Phone*

Emergency Contact/Keyholder (If not requestor)

Emergency Contact Phone Number

Burglar Alarm System?*

Timer for Lights?

Additional Comments

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