Fillable Printable Affidavit of Equipment of Detectors
Fillable Printable Affidavit of Equipment of Detectors
Affidavit of Equipment of Detectors
Telephone (845) 429-2200
TOWN OF HAVERSTRA W
BUILDING DEPART MENT
ONE ROSMAN ROAD
GARNERVILLE, NEW YORK, 10923
Fax: (845) 786-7647
AFFIDAVIT
SMOKE DETECTOR & CARBON MONOXIDE
STATE OF NEW YORK )
COUNTY OF ROCKLAND )
I ____________________________________________________________________________being duly sworn,
deposes and says:
1. That I currently reside at:___________________________________________
___________________ ______________________ ______________________ _____
2. That the premises at: ________________________________________________
____________________________________________________________________
New York, is presently equipped with a smoke detector and a carbon monoxide detector
located adjacent to the bedrooms and that these systems are presently in good working
order.
That this Affidavit is being given with the knowledge that it will be relied upon by the
Town of Have rs tr aw in o rd er to appr ov e a Certificate of Occupancy and A Violation
Search for these premises.
Tax Designation: Section;_________________ Block:___________ Lot:_____
___________________________
Signature
Sworn to before me this ____ day of ____________, 20 ___
__________________________________
