Affidavit of Smoke Alarm and Carbon Monoxide Alarm Installation

STATE OF NEWYORK
AFFIDAVIT OF COM PLIANCE OF SMOKE ALARM & CARBON
MONOXIDE ALARM INSTALLATION
IN ONE AND TWO FAMILY HOME
State of New York )
SS:
County of Orange )
1 (I) (WE) are the transferors (s) of the property described herein, and attest that the
property at the time of transfer has installed on its premises an operable single or
multiple stati on smoke alarm s and single or multiple carbon monox ide alarm s.
2. The property is a (one) (two) family dwelling located at:
Address:_________________________________________________________
Town: _____________________ County:____________________________
State: _____________________ Zip: ________________________________
3 (I) (WE) make this affidavit in accorda nce w ith Se c tion 373 subdivision 5 of the
Executive Law,
Transferor: ____________________________L.S.
Transferor______________________________L.S.
Sworn to before me this___ day
of __________________, 20__ _
Notary Public
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