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Please complete and submit the RUOK form below. You will then be contacted by someone from the Constable Precinct 3 office.
Date
First Name*
Last Name*
Date of Birth*
Street Address*
City*
State*
Zip Code*
Home Phone ###-###-####*
Age*
Are you living alone?*
Occupants*
First Name
Last Name
Relationship
Street Address
City
State
Zip Code
Home Phone
Work Phone
Cell / Alt Phone
Extra Key
Extra Key Location
Pets
Description
Life Alert
Alarm?
Company
Vehicle?
Make
Model
Year
Color
Able to walk?
Physical Impairments
Gender
Ethnicity
Marital Status
Race (Check all that apply)
I, the undersigned, freely and voluntarily give permission to the Harris County Pct. 3 Constable's Office to enter my residence for the purpose of checking on the well-being of myself or my family. To sign the form, please type in your full name in the Signature field below:
Signature*
Date*
