MIAMI-DADE POLICE DEPARTMENT Account

ALARM PERMIT REGISTRATION FORM

Phone # (305) 471-3600 Fax # (305) 471-3601

Return with Payment to: Miami-Dade Police Department False Alarm Enforcement Unit9105 NW 25th Street, Rm #1119Miami, FL 33172

Expires: Annual Alarm Permit Fee Annual Renewal Permit Fee

Alarmed Location1

Occupant Name or Business Name

Suite/Apt#Address

City State Zip Phone

Responsible Party2 Phn1

Phn2Name

Phn3

Address

Phn4

City State Zip E-mail address

Contact Names3Contact 1

Phn1

Phn2

Name

Contact 2 Phn1

Phn2Name

Additional Information4Special Conditions/ Hazards

Alarm Companies5 Not Monitored

Monitored By

Phn1

Installed By

Phn1

Please review information for accuracy; update and return along with your payment. Failure to register mayforfeit police response.

I hereby certify that the above information is accurate to the best of my knowledge.

Signature ________________________________ Date _________