| PENN TOWNSHIP POLICE
DEPARTMENT |
| 20 Wayne Avenue, Hanover
PA 17331 |
| ALARM REGISTRATION FORM |
| Permit # |
PERMIT FEE $10.00 |
Issued |
Expiration |
| Type of System (Circle): |
Burglary |
Fire |
Hold Up |
Other |
| Residential Alarm |
| Name ___________________________ |
Phone: |
Home ________ |
Work _________ |
| Street Address
___________________________________________________________ |
| Commercial Alarm |
| Business
__________________________________________ |
Phone _______________ |
| Complete Street Address
_________________________________________________________ |
| Owner's Name
______________________________________ |
Phone _______________ |
| Owner's Mailing Address
_____________________________________________________________ |
| Communications Type (Circle) |
Central Station |
Direct Police Connect |
|
|
|
|
Tape Dialer |
Audible |
| Local audible automatic cut-off time
____________ minutes |
| EMERGENCY PERSONNEL |
|
|
|
|
|
Has Key |
| 1. Name
___________________________________ |
Home phone __________ Work ___________ |
Y N |
| 2. Name
___________________________________ |
Home phone __________ Work ___________ |
Y N |
| 3. Name
___________________________________ |
Home phone __________ Work ___________ |
Y N |
| SPECIAL INFORMATION: Guard on site, Dogs
in building, Hazardous material, Etc. |
| ________________________________________________________________________ |
| Alarm Company
__________________________________________________________ |
| Street Address
___________________________________________________________ |
| City
______________________________________ |
State ________ |
Zip __________ |
| Telephone: Day
___________________________ |
Night _______________________ |
| By signing this form we acknowledge that the
above information is correct and this information may only be given to the
authority having jurisdiction. |
| SUBSCRIBER:
_____________________________________________________________ |
| The initial permit fee and annual permit fee
shall entitle the permit holder to unlimited actual alarm calls and three
(3) false alarm calls per year. Each false alarm call after the three (3)
in any given annual permit period shall require the payment of a fee of
fifty dollars ($50). |
| Application Received By
_______________________ |
Fee Paid: ______ Yes ______ Exempt |
| Amt Paid ________ |
Payment Form: _____Cash _____Personal Ck
_____Business Ck |
| Fee Receipt # _____________ |
If Check received: Check #__________
Issue Date __________ |
| Application Approved By:
___________________________________ Date: ________________________ |