Form DSFS54 "Modular Building Program Label Request Form" - New Hampshire

What Is Form DSFS54?

This is a legal form that was released by the New Hampshire Department of Safety - a government authority operating within New Hampshire. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on October 1, 2018;
  • The latest edition provided by the New Hampshire Department of Safety;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form DSFS54 by clicking the link below or browse more documents and templates provided by the New Hampshire Department of Safety.

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Download Form DSFS54 "Modular Building Program Label Request Form" - New Hampshire

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STATE OF NEW HAMPSHIRE DEPARTMENT OF SAFETY
Division of Fire Safety & Emergency Management
OFFICE OF THE STATE FIRE MARSHAL
Paul J Parisi
, State Fire Marshal
Office: 110 Smokey Bear Blvd, Concord, NH
Mailing Address: 33 Hazen Drive, Concord, NH 03305
603-223-4289, FAX 603-223-4295
MODULAR BUILDING PROGRAM
LABEL REQUEST FORM
Please type or print legibly
Date:____________
Agency ID # ________________
Agency Name:
_____________________________________________________
Address:
_____________________________________________________
City:________________________ State: _________________ Zip:______________
We, the undersigned, agree to hold the enclosed labels (serial numbers as noted
below), on consignment for the State of New Hampshire, and forward $100.00 per label
as they are used and/or issued to approved manufacturers. In addition, we will forward
a minimum of a monthly report to the address shown above indicating label inventory
and status.
Number of labels requested:
__________________
Signed____________________________________________ Date:______________
For Department Use Only:
Date Received
Filled By
Date Filled
Starting Number
Ending Number
Total Labels
DSFS 54 rev. 10/18
TDD Access: Relay NH 1-800-735-2964
ARSON HOTLINE 1-800-400-3526
Reset Form
STATE OF NEW HAMPSHIRE DEPARTMENT OF SAFETY
Division of Fire Safety & Emergency Management
OFFICE OF THE STATE FIRE MARSHAL
Paul J Parisi
, State Fire Marshal
Office: 110 Smokey Bear Blvd, Concord, NH
Mailing Address: 33 Hazen Drive, Concord, NH 03305
603-223-4289, FAX 603-223-4295
MODULAR BUILDING PROGRAM
LABEL REQUEST FORM
Please type or print legibly
Date:____________
Agency ID # ________________
Agency Name:
_____________________________________________________
Address:
_____________________________________________________
City:________________________ State: _________________ Zip:______________
We, the undersigned, agree to hold the enclosed labels (serial numbers as noted
below), on consignment for the State of New Hampshire, and forward $100.00 per label
as they are used and/or issued to approved manufacturers. In addition, we will forward
a minimum of a monthly report to the address shown above indicating label inventory
and status.
Number of labels requested:
__________________
Signed____________________________________________ Date:______________
For Department Use Only:
Date Received
Filled By
Date Filled
Starting Number
Ending Number
Total Labels
DSFS 54 rev. 10/18
TDD Access: Relay NH 1-800-735-2964
ARSON HOTLINE 1-800-400-3526
Reset Form