Form EA121212 "Alarm System Registration & Renewal Form" - City of Bethlehem, Pennsylvania

What Is Form EA121212?

This is a legal form that was released by the Police Department - City of Bethlehem, Pennsylvania - a government authority operating within Pennsylvania. The form may be used strictly within City of Bethlehem. As of today, no separate filing guidelines for the form are provided by the issuing department.

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Download Form EA121212 "Alarm System Registration & Renewal Form" - City of Bethlehem, Pennsylvania

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CITY OF BETHLEHEM ALARM SYSTEM REGISTRATION & RENEWAL
#________________
CHECK ONE OF THE BELOW:
Permit
REGISTRATION: [ ] BUSINESS ALARM -
FILING FEE $50.00
RENEWAL: [ ] BUSINESS ALARM– (NO FEE)
--
[ ] RESIDENTIAL ALARM - FILING FEE $25.00
[ ] RESIDENTIAL ALARM - (NO FEE)
Name of Occupant or Business: _________________________________________________________________________________________________
Full Address: _______________________________________________________________________________________________________________
Telephone: _____________________ Cell Phone: ______________________Email Address: _______________________________________________
Occupant or Business Mailing Address (if different from above): ______________________________________________________________________
Full address: ________________________________________________________________________________________________________________
Telephone: _______________________Cell Phone: _______________________ Email Address: ___________________________________________
Alarm Type: Burglar
Fire Hold-Up
Medical Emergency
Panic
Other __________________________
[ ]
[ ]
[ ]
Type of Dwelling:
Business/Commercial
Student Apartments
Single Residence [ ] Multiple Dwelling
Communications Type: Central Station Local Sounding Only (Audible Alarm Must Shut Off In 10 Minutes) Silent
NOTIFICATION LIST (Minimum of 2)
Person: ________________________________________ ADDRESS: __________________________________________________________________
Home Phone: _____________________________
Work Phone: __________________________
Cell, Pager, Other: ________________________
[ ] YES
[ ]
Title/Relationship: ________________________________________ Has Keys:
NO
Person: ________________________________________ ADDRESS: __________________________________________________________________
Home Phone: _____________________________
Work Phone: __________________________
Cell, Pager, Other: ________________________
[ ] YES
[ ]
Title/Relationship: ________________________________________ Has Keys:
NO
Person: ________________________________________ ADDRESS: __________________________________________________________________
Home Phone: _____________________________
Work Phone: __________________________
Cell, Pager, Other: ________________________
[ ] YES
[ ]
Title/Relationship: ________________________________________ Has Keys:
NO
Special Information: (Guard on Site, Dogs in Building, Hazardous Materials, etc.) __________________________________________________________
Alarm Company: ___________________________________________ Address: __________________________________________________________
City: _________________________ State: _______________Zip: _____________________Telephone: _______________________________________
Signing this form acknowledges that the above information is correct and that it may only be given to the authority having jurisdiction.
Subscriber: __________________________________________
Alarm Company: ___________________________________Date:
CHECK OR MONEY ORDER, MADE PAYABLE TO THE CITY OF BETHLEHEM.
MAIL TO: CITY OF BETHLEHEM ALARM ADMINISTRATOR, 10 EAST CHURCH ST, BETHLEHEM, PA 18018
CALL CRIME PREVENTION (610-865-7181) WITH QUESTIONS
ST
NOTE: THERE IS A $25.00 PENALTY FOR FAILING TO RENEW THE REGISTRATION AFTER JANUARY 31
OF EACH YEAR
Form EA121212
CITY OF BETHLEHEM ALARM SYSTEM REGISTRATION & RENEWAL
#________________
CHECK ONE OF THE BELOW:
Permit
REGISTRATION: [ ] BUSINESS ALARM -
FILING FEE $50.00
RENEWAL: [ ] BUSINESS ALARM– (NO FEE)
--
[ ] RESIDENTIAL ALARM - FILING FEE $25.00
[ ] RESIDENTIAL ALARM - (NO FEE)
Name of Occupant or Business: _________________________________________________________________________________________________
Full Address: _______________________________________________________________________________________________________________
Telephone: _____________________ Cell Phone: ______________________Email Address: _______________________________________________
Occupant or Business Mailing Address (if different from above): ______________________________________________________________________
Full address: ________________________________________________________________________________________________________________
Telephone: _______________________Cell Phone: _______________________ Email Address: ___________________________________________
Alarm Type: Burglar
Fire Hold-Up
Medical Emergency
Panic
Other __________________________
[ ]
[ ]
[ ]
Type of Dwelling:
Business/Commercial
Student Apartments
Single Residence [ ] Multiple Dwelling
Communications Type: Central Station Local Sounding Only (Audible Alarm Must Shut Off In 10 Minutes) Silent
NOTIFICATION LIST (Minimum of 2)
Person: ________________________________________ ADDRESS: __________________________________________________________________
Home Phone: _____________________________
Work Phone: __________________________
Cell, Pager, Other: ________________________
[ ] YES
[ ]
Title/Relationship: ________________________________________ Has Keys:
NO
Person: ________________________________________ ADDRESS: __________________________________________________________________
Home Phone: _____________________________
Work Phone: __________________________
Cell, Pager, Other: ________________________
[ ] YES
[ ]
Title/Relationship: ________________________________________ Has Keys:
NO
Person: ________________________________________ ADDRESS: __________________________________________________________________
Home Phone: _____________________________
Work Phone: __________________________
Cell, Pager, Other: ________________________
[ ] YES
[ ]
Title/Relationship: ________________________________________ Has Keys:
NO
Special Information: (Guard on Site, Dogs in Building, Hazardous Materials, etc.) __________________________________________________________
Alarm Company: ___________________________________________ Address: __________________________________________________________
City: _________________________ State: _______________Zip: _____________________Telephone: _______________________________________
Signing this form acknowledges that the above information is correct and that it may only be given to the authority having jurisdiction.
Subscriber: __________________________________________
Alarm Company: ___________________________________Date:
CHECK OR MONEY ORDER, MADE PAYABLE TO THE CITY OF BETHLEHEM.
MAIL TO: CITY OF BETHLEHEM ALARM ADMINISTRATOR, 10 EAST CHURCH ST, BETHLEHEM, PA 18018
CALL CRIME PREVENTION (610-865-7181) WITH QUESTIONS
ST
NOTE: THERE IS A $25.00 PENALTY FOR FAILING TO RENEW THE REGISTRATION AFTER JANUARY 31
OF EACH YEAR
Form EA121212