Town Of Crawford
Smoke Detecting Alarm Affidavit

Town Of Crawford Smoke Detecting Alarm Affidavit

TOWN OF CRAWFORD
BUILDING DEPARTMENT
P.O. BOX 109
PINE BUSH, N.Y. 12566

STATE OF )

COUNTY OF )

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 a single station smoke detecting alarm device.
3. I make this affidavit in accordance with Section 378 subdivision 5 of the Executive Law.

Sworn to before me this
day of , 20.

Notary Public