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ALARM USER PERMIT APPLICATION Date Received Date Issued 1. Name of User: A: (Name of business, if residence, name of two adults) Person in Control: B: 2. Date of Birth: A: B: 3. Alarm Location Residence Business Financial Government 4. If residence: House Condominium Apartment Other 5. Type of Business: 6. Street Address Nearest Cross St. 7. City State Zip 8. Home Phone Work Phone (#1A) Work Phone (#1B) 9. Mailing Address (if different from street address) 10. New System Installation date: 11. Existing System Installation date: Type of Burglary Alarm System: (check only one) 12. Audible Only (system sounds a siren/bell only) Monitored Only (system signals alarm company only) Both Audible and Monitor 13. Name of Alarm Monitoring Company 24 Hr Tel: 14. Name of Installation/Service Company 24 Hr Tel: Type of User Activated Alarms (check appropriate line(s) if a user of the alarm system can activate these special emergency conditions even when the burglar alarms system protecting the premises is turned off) 15. Robbery/Holdup (a silent signal only is sent to the alarm company) 16. Panic (a silent/bell sounds at the location and a silent signal is also sent to the alarm company) Type of Other Emergency Signals: 17: Fire Alarm 18: Medical Alert List two persons other than listed in line 1 who can be contacted with keys to the premises to assist police and/or fire department to secure the premises or reset a malfunctioning alarm (Must List Two) 19. Name: 20: Home Phone ( ) Work Phone ( ) Pager 21. Name: 22: Home Phone ( ) Work Phone ( ) Pager 23. Instructions to help officers respond/search your premises (example: directions, guard dog, etc.) 24. Authorized signature Date: 25. Print Name Please complete and return to: Attn: Alarms Farmington Police Department 800 Municipal Drive Farmington, NM 87401-2663 REC 013 001