Alarm Registration Form

2. Alarm Registration Form
   York County does not issue permit numbers for alarm systems being registered. However, York County Ordinance requires all alarms be registered with the county.

   York County does not issue permit numbers for alarm systems being registered. However, York County Ordinance requires all alarms be registered with the county.

4. Date:*
   Date:

6. Alarm Location Address:*

7. Apartment / Suite #:

9. Mailing Address (if different):

11. City*

12. State

13. Zip Code

15. Business / Resident Name:*

17. Home Phone:

18. Work Phone:

19. Alternate Number:

21. Name of Power Company:*

23. Alarm Company Name:*

24. Alarm Company Phone:*

26. Type of Alarm:*

    1. Fire
    2. Medical
    3. Burglar
    4. Other

28. Other Alarm Type

30. Name of Subdivison/Office Complex:

34. Emergency Contact #1 Name:

36. Emergency Contact #1 Home Phone:

37. Emergency Contact #1 Cell Phone:

39. Emergency Contact #1 Work Phone:

40. Emergency Contact #1 Other Phone:

44. Emergency Contact #2 Name:

46. Emergency Contact #2 Home Phone:

47. Emergency Contact #2 Cell Phone:

49. Emergency Contact #2 Work Phone:

50. Emergency Contact #2 Other Phone:

54. Emergency Contact #3 Name:

56. Emergency Contact #3 Home Phone:

57. Emergency Contact #3 Cell Phone:

59. Emergency Contact #3 Work Phone:

60. Emergency Contact #3 Other Phone:

64. Brief Directions from Highway:

66. Other Important Information:

Leave This Blank:


67. 1. Receive an email copy of this form.
68. Email address

    This field is not part of the form submission.

69. Submit

* indicates a required field