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Alarmed Premise Application

NEW ALARM Two-Year Permit Fees

$90 Residential $180 Commercial

RENEWALS Two-Year Permit Fees Due January 1st

$60 Residential $120 Commercial

Make check payable to the Village of Tarrytown, return to Tarrytown Police Department, Attn Records, One Depot Plaza, Tarrytown NY 10591.

Please note: your permit is not active until payment is received

*Health-related Alarm Devices: Anyone possessing a health-related alarm device shall be exempt from the permit fees as established by the Village of Tarrytown. Said persons shall be subject to all other provisions of this local law.*

Premise Phone Number

Are you a...

Commercial Applicant

Residental Applicant

Business Name (if applicable)

Please provide name(s), address (es) and telephone number(s) of AT LEAST ONE person who can be contacted to open the protected premise and reset/disconnect the alarm system. Commercial Applicant: Please provide information for AT LEAST TWO owners/employees that may be contacted. Fill out all information.

Alarm System Information

Audible Device

Bell

Siren

None

Other

Does audible device have an automatic shut-off

Yes

If yes, after how many minutes?

Is system a direct dialer/tape station?

Direct Dialer

Tape Station

Not applicable

Is system monitored by a central station

Yes

Alarm Company

Address

Company Telephone Number

Does the alarm company dispatch its own personnel to investigate activated alarms?

Yes

Type of Alarm (Check all that apply)

Burglary

Hold-Up

Fire

Panic

Medical

Other

Alarm Turn-off location

Special Conditions: Please indicate if any personal precautions should be taken in regards to your premise, i.e. Guard Dogs, Handicapped/Invalids, Hazardous Materials, potential officer safety hazards, etc.:

Sign Here

First Name

Last Name

Choose how to sign

Draw Type

I agree to electronically sign and to create a legally binding contract between the other party and myself, or the entity I am authorized to represent.