Fillable Printable Affidavit of a Smoke Detecting Alarm's Existence

Affidavit of a Smoke Detecting Alarm's Existence

TOWN OF CRAWFORD

BUILDING DEPARTMENT

P.O. BOX 109

PINE BUSH, N.Y. 12566

State of New York

County of Orange

I, being duly sworn, deposes and say:

1. I am the owner of property located at:____________________________

2. I attest that the property has installed on its premises an

operable single station smoke detecting alarm de vice .

3. I ma ke th is aff i davi t in accor da nc e wit h Sec ti on 37 8 s ubd iv isio n 5 of the

Executive Law.

_____________________________

Sworn to before me this

____day of _________ 20___

__________________________

Notary Public