AFFIDAVIT OF COMPLIANCE WITH
CARBON MONOXIDE DETECTOR REQUIREMENT
FOR ONE AND TWO FAMILY DWELLINGS
The undersigned, being duly sworn, depose and say that under penalty of perjury that
they are the grantor of the real property or of the cooperative shares in a cooperative
corporation owning real property located at:
Street Address Unit/Apt.
, New York. (the “Premises”);
That the premises is a one or two family dwelling, or a cooperative apartment or
condominium unit in a one-or-two family dwelling, and that 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 concerning carbon monoxide
Name of Grantor Name of Grantee
Signature of Grantor Signature of Grantee
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 code.
American Land Services, Inc.
One Penn Plaza, Suite 3406, New York, NY 10119 Tel: 212.239.1000 Fax: 212.239.6970
6800 Jericho Turnpike, Syosset, NY 11791 Tel: 516.921.4466 Fax: 516.921.3433