Carbon Monoxide Alarm Verification Form
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1CARBON MONOXIDE ALARM VERIFICATION FORM
RENTAL PROPERTY INFORMATION
Rental Property Address ________________________________________________________ Unit #______ Zip Code __________
_____________________________________________
Property Account/Tax ID:
Council District __________________
Type of Dwelling: Single Family/Duplex/ Row Home/Townhouse (Complete one form per unit)
PROPERTY OWNER INFORMATION
Property Owner Name _________________________________________________________ Home Phone ___________________
Property Owner Address _______________________________________________________ Zip Code ______________________
Email Address ________________________________________ Cell Phone ____________________________________________
LEGAL AGENT INFORMATION
Legal Agent Name ___________________________________________________________ Daytime Phone __________________
Legal Agent Address __________________________________________________________________________________________
City ________________________________________________ State _________________ Zip Code ________________________
Email Address ________________________________________ Cell Phone _____________________________________________
This form is to verify that the owner and tenant have complied with the Carbon Monoxide Alarm Law of Baltimore County (BCC 35-5-213.1)
The Carbon Monoxide Alarms have been installed in accordance with the manufacturers’ specifications.
An alarm is installed in the common area outside of each sleeping areas.
Information was provided by the owner on alarm testing and maintenance to at least one adult occupant of the dwelling unit.
The owner will keep a signed copy of this form acknowledging receipt by the tenant.
The owner will provide an alarm designed to alert hearing-impaired residents if an individual who is hearing-impaired
occupies the dwelling unit and has requested the installaton of the alarm by certified mail
The tenant agrees to test and maintain the carbon monoxide alarm according to management guidelines.
The tenant must replace the batteries in the alarm as needed, and notify management by certified mail immediately of any
malfunctions or other problems with the carbon monoxide alarm. Upon receipt of such notice, the owner must repair or
replace the alarm.
The tenant may not remove or disconnect the alarm and may not remove the batteries or otherwise render the alarm
inoperable.
Exempt: The dwelling is exempt from this law because it meets all of the following criteria:
___ No Fuel Burning Equipment ___ No attached garage ___ No wood burning fireplace/pellet stove
OWNER SIGNATURE _____________________________________________________________
Date ____________________
TENANT SIGNATURE ____________________________________________________________
Date_____________________
Please return completed form to:
Rental Housing Registration
111 W. Chesapeake Ave, Room G-14
Towson MD 21204
THIS FORM MUST BE COMPLETED AND SUBMITTED WITH EVERY CHANGE OF TENANT
PAI CER7
REV 11/11
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