Coldwater Police Department

"Serving & Protecting the Public Since 1883"

303 W. Main Street   Coldwater, Ohio 45828

Bus. phone (419) 678-2356

TRAVEL ITINERARY

Name:                                                                        Phone:                                                                   

Address:                                                                                                                                                   

Make of Vehicle:                                                        License Plate:                                                   

Next of Kin:                                                                 Phone:                                                               

Address:                                                                                                                                                   

Who to notify in case of accident:                                                                                                       

Phone:                                                 Address:                                                                                      

Date Leaving:                                                            Time Leaving:                                                    

Date of Return:                                                          Time returning:                                                   

Destination:                                                                                                                                               

Phone at destination:                                                   

Others checking residence:                                                                                                                   

Phone:                            Others with keys to residence:                                                                       

Phone:                                       

Lights Burning:     YES    NO          ( Where )                                                                                           

Vehicles in drive or garage:                                                                                                                       

Remarks:                                                                                                                                                       

This information shall remain confidential.  Please contact the Police Department if you return early. Gery Thobe, Chief

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