Vermont State Police
|Vermont State Police |[pic] |Phone: 802-241-5397 |
|45 State Drive | |State Police Use Only: |
|Waterbury, VT 05671-1300 | |Alarm # |
|ALARM REGISTRATION |
|Mail this form along with a check in the amount of $50.00 to: |
|Vermont State Police |
|ATTN: Alarm Coordinator |
|45 State Drive |
|Waterbury, VT 05671-1300 |
|Please make checks payable to The Department of Public Safety. There is a $20.00 fee for any returned checks. |
|PROPERTY OWNER |
|Name - First |Middle |Last |Date of Birth (mm/dd/yyyy) |
| | | | |
|Driver’s License Number |State |
| | |
|ALARMED PROPERTY INFORMATION |
|If this is a business, please list the name of the business: |
|Premise Phone # |911 Property Number and Street Address |Town, Zip Code |
|Previous Property Owner(s) Name(s): |
|If owner’s primary residence is not the alarmed residence, please complete the following: |
|Legal Address |Mailing Address (if different from legal) |
| | |
|Owner Contact Numbers |Home |( ) - |Work |( ) - Ext. |
| |Cell |( ) - |Email | |
|Alarm Code/Word (to be given to the State Police for verification purposes only. This Alarm Code/Word doesn’t need to be the pin # to your alarm system |
|this can be a series of numbers or words to be given to the State Police in the event of an alarm activation): |
|ALARM MONITORING COMPANY |24 Hour Dispatch Center |
| | ( ) - |
|ALARM INSTALLATION/SERVICE COMPANY TELEPHONE NUMBER |
| | ( ) - |
|ACKNOWLEDGEMENT |
|I acknowledge that the Vermont State Police bear no responsibility for the performance of the alarm equipment. Furthermore, I have read the State Police |
|policy and understand that State Police response will be determined based on past performance and history of my alarm system and the circumstances at the |
|time of the alarm activation. |
|I acknowledge that after the 1st false alarm (within a calendar year), there will be a fee assessed for future false alarms and payment must be received |
|within 30 days of the invoice date to avoid being placed in non-response mode. I also acknowledge that after three (3) false alarms (per calendar year), my|
|alarm will be placed in non-response mode. At that time, should I wish to have the State Police begin responding again, I must comply with the |
|reinstatement policy and procedures. I understand that my alarm will remain in non-response mode until compliance with the reinstatement policy and |
|procedures are met. |
|I acknowledge that it is my responsibility to keep all key holder information current with my alarm company and/or monitoring company. I have advised all |
|key holders associated with my account that it’s their responsibility to respond with the State Police for an interior inspection, but sometimes the key |
|holder may be the only resource for responding. Should there be any indication that a crime has occurred or is occurring the responder will contact 911 |
|immediately. |
|I acknowledge that it’s my responsibility that the Vermont State Police has current and correct contact information on file for me or my business. |
|I understand that it’s my responsibility to provide clear and accurate directions to my home or business to the Vermont State Police. |
|Date |Signature of Property Owner |
| | |
| | |
DPS AF#2 (2019)
|DIRECTIONS TO THE PROPERTY (FROM MAJOR ROADWAY) |
| |
| |
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