This application must be completed in full before a permit can be issued. All information must be current, and it will be the responsibility of the permit holder to ensure that this information remains current at all times.
Type of Alarm (Circle Appropriate Descriptions):
RESIDENTIAL BUSINESS
FIRE INTRUSION ROBBERY PANIC
PERMIT FEES: Original $25.00 RENEWAL $10.00
Exemptions: Principal occupant age 65 or older _______ Government Facility_______
A permit fee must accompany all permit applications. Checks should be made payable to:
TOWN OF AMHERST, N.H.
Residence / Business Name: __________________________________DOB: _____________
Address: ______________________________________________Telephone no. ____________
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Type of Alarm (Circle Appropriate One):
Dial Alarm Direct Alarm Local Alarm
Alarm Monitoring Company ______________________________ Telephone no. ____________
Does the alarm system automatically reset? Yes _____ No ____ How soon? ________________
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Persons(s) to be contacted when alarm activates:
Name: __________________________________________________________________
Address: ________________________________________ Phone: __________________
Name: __________________________________________________________________
Address: ________________________________________ Phone: __________________
Questions concerning this Ordinance or Permit Application should be brought to the Amherst Police Department, 673-4900.
We, the undersigned, by virtue of our signature to this application, hereby acknowledge that we have read the Town of Amherst intrusion alarm system ordinance regulating the conduct of the maintenance of an intrusion alarm, and we agree to abide by the same. We further agree and consent to the imposition of the charges and penalties set forth in said ordinance in the event that the maintenance and/or operation of the system which is the subject matter of this application occasion the necessity for same. We expressly request that all records with respect to this application be kept confidential.
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Signature