Alarm Registration-Trumbull Police Department Form

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Trumbull Police Department
“No alarm user shall use an alarm system without first obtaining a permit for such alarm
system from the Town…Any alarm user who fails to register their alarm system will be
charged $100 for each year said alarm system is not registered…In addition, the alarm user
shall pay $50 for each false alarm until the alarm is registered in accordance with these
provisions… Whenever authenticated information changes, user must notify the Town
within 60 days of the change.”
ALARM REGISTRATION
New Registration
Renewal
No longer an alarm at this location
Premise Information:
__________________________ __________________________
:
Resident or Business Name
(Last Name) or (Business Name)
(First Name)
Residence or Business Address:_______________________________________________________________
Mailing Address, if Different:__________________________________________________________________
Premise Phone #______________________________ Business Phone #_____________________________
Cell Phone#__________________________________ Other_______________________________________
Alarm Information:
This is an application to operate an alarm and/or signaling system as indicated. Please select ALL that apply:
____ Burglar
____ Hold Up/Panic
____ Central Station Monitored
____ Local Alarm ONLY
Name of Alarm Service Company:______________________________
Phone#_______________________
Address:_________________________________________ Contact Person:___________________________
Name of Central Monitoring Station (where system is monitored):_____________________________________
Address:___________________________________________________ Phone#________________________
Authorized Key Holders/Account Authenticators (indicate N/A if no other key holder):
Name:______________________________ Home Phone#:_______________ Cell Phone #________________
Address:_________________________________________
Business Phone#:_________________________
Name:______________________________ Home Phone#:______________ Cell Phone #________________
Address:_________________________________________
Business Phone#:_________________________
___I hereby acknowledge the above information is correct to best of my ability and I understand the regulations of
the Trumbull Alarm Ordinance available at:
Applicant Signature:___________________________________
Date:____________________________
Mail this Registration Form to:
Trumbull Police Department
C/O Records Division
158 Edison Rd.
Trumbull, CT 06611

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