MIAMI-DADE POLICE DEPARTMENT Account ALARM …

MIAMI-DADE POLICE DEPARTMENT Account

ALARM PERMIT REGISTRATION FORM

Phone # (305) 471-3600

Fax # (305) 471-3601

Return with Payment to: Miami-Dade Police Department False Alarm Enforcement Unit 9105 NW 25th Street, Rm #1119 Miami, FL 33172

Annual Alarm Permit Fee

1 Alarmed Location

Annual Renewal Permit Fee

Expires:

Occupant Name or Business Name

Address

City

State Zip

Phone

2 Responsible Party

Phn1

Name Address

City

State Zip

3 Contact Names

Contact 1

Name

Contact 2

Name

E-mail address

Phn2 Phn3 Phn4

Phn1 Phn2 Phn1 Phn2

4 Additional Information

Special Conditions/ Hazards

5 Alarm Companies

Monitored By

Not Monitored

Suite/Apt#

Installed By

Phn1

Phn1

Please review information for accuracy; update and return along with your payment. Failure to register may forfeit police response.

I hereby certify that the above information is accurate to the best of my knowledge.

Signature ________________________________ Date _________

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