AFFIDAVIT OF COMPLIANCE WITH SMOKE DETECTOR AND
CARBON MONOXIDE DETECTOR REQUIREMENTS
FOR ONE AND TWO FAMILY DWELLINGS
STATE OF NEW YORK )
COUNTY OF )
The undersigned, being duly sworn, deposes and says under the penalty of perjury that:
1. I am the grantor of the real property or of the cooperative shares in a cooperative corporation
owning real property located at:
, , New York (the “Premises”);
2. The Premises is a one or two family dwelling, or a cooperative apartment or condominium unit
used as a residence;
3. Installed in the Premises is an approved and operational carbon monoxide detecting device in
compliance with subdivision 5-a of Section 378 of the Executive Law of the State of New York.
4. Installed in the Premises is an approved and operational single station smoke detecting alarm
device in compliance with subdivision 5 of Section 378 of the Executive law of the State of New York.
5. These statements are made with the knowledge that a willfully false representation is unlawful
and is punishable as a crime under article 210 of the Penal Law of the State of New York.
6. The word “grantor” shall be construed to read in the plural whenever the sense of this affidavit
Sworn to before me this
day of , 20 .