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Carbon Monoxide-Smoke Detector Affidavit

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Carbon Monoxide-Smoke Detector Affidavit Powered By Docstoc
					                      AFFIDAVIT OF COMPLIANCE WITH SMOKE DETECTOR AND
                          CARBON MONOXIDE DETECTOR REQUIREMENTS
                             FOR ONE AND TWO FAMILY DWELLINGS

STATE OF NEW YORK                         )
                                          ) ss.:
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”);
Street Address

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
so requires.

___________________________                               ____________________________


Sworn to before me this
      day of      , 20            .

______________________________
Notary Public




                                             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
                                             AmericanLandServices.com

				
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posted:10/8/2011
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