Fillable Printable Affidavit of Detetors' Installation

Affidavit of Detetors' Installation

MAYOR

Michael Esmay

TRUSTEE &

DEPUTY

MAYOR

Kar en T ara pat a

TRUSTEES

Ja m e s Ande rson

Vincent S. Morgan

Peter Malcolm

VILLAGE OF UPPER NYACK

328 NORTH BROADWAY

UPPER NYACK, NEW YORK 10960 *

*INCORPORATED 1872 *

Tel. 8 45-358- 0084 FAX, 845- 358-07 41

uppernyack@ optonline. net

www.uppernyack-ny.us

Village Clerk

Carol G.Brotherhood

Village Treasurer

Barry MacCartney

VILLAGE ATTO RNEY

Robert P. Lewis

AFFIDAVIT OF COMPLIANCE ROCKLAND

COUNTY SANITARY CODE §13.34 AND §13.35. S MOKE A ND

CARBON MONOXIDE ALARM INSTALLATION

I am an owner of the property described herein:

Tax designation:

Address:

Upper Nyack, NY 10960

County of Rockland

State of New York

I attest that at the time of transfer, all sleeping areas and access hallways have smoke

detector (s) and carbon monoxide detector (s) installed in accordance with the above

law.

Owner / Transferor

L.S.

STATE OF NEW YORK }

COUNTY OF ROCKLAND } SS.:

Sworn to before m e this

day of

Notary Public Seal