Fillable Printable Affidavit of Compliance with Smoke Detector and Carbon Monoxide Detector Requirement

Affidavit of Compliance with Smoke Detector and Carbon Monoxide Detector Requirement

AFFIDAVIT OF COMPLIANCE WITH SMOKE DETECTOR AND

CARBON MONOXIDE DETECTOR REQUIREMENTS

FOR ONE AND TWO FAMILY DWELLINGS

STATE OF NEW YORK )

) ss.:

COUNTY OF )

The undersigned, being duly sworn, deposes and says under the penalty of perjury that:

1. I am the grantor of the real property or of the cooperative shares in a cooperative corporation

owning real property located at:

, , New York (the “Premises”);

Street Address

2. The Premises is a one or two family dwelling, or a cooperative apartment or condominium unit

used as a residence;

3. Installed in the Premises is an approved and operational carbon monoxide detecting device in

compliance with subdivision 5-a of Section 378 of the Executive Law of the State of New York.

4. Installed in the Premises is an approved and operational single station smoke detecting alarm

device in compliance with subdivision 5 of Section 378 of the Executive law of the State of New York.

5. These statements are made with the knowledge that a willfully false representation is unlawful

and is punishable as a crime under article 210 of the Penal Law of the State of New York.

6. The word “grantor” shall be construed to read in the plural whenever the sense of this affidavit

so requires.

___________________________ ____________________________

Sworn to before me this

day of , 20 .

______________________________

Notary Public