Town Of Haverstraw
Smoke Detector And
Carbon Monoxide Affidavit

Town Of Crawford Carbon Monoxide Detector Alarm

STATE OF )

COUNTY OF )

I , being duly sworn, deposes and say:

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 Haverstraw in order to approve 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.