Alarm Registration Application
Date____________ New Replace Decal #_____________ Update Renewal
Office Use Only
PHrmit #:
Clerk:
Amount:
Date Issued:
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Entered by:
I. Subscriber Information
(Please type or print legibly with ballpoint pen)
Commercial Residential Owner occupied Rental
Business/Resident NameV
Street Address Work #
Mailing Address AGGLWLRQDOPhone
Property Owner (if different)
Owner’s Address Owner’s Phone
Animals on Premise Yes No Type Number of Animals
Drivers License # and State
II. Alarm Company Information
Type of Alarm System: Audible Silent Not Monitored By An Alarm Company
Alarm Servicing Company Phone
Alarm Monitoring Company Phone
III. Emergency Notification
List two responsible representatives (other than the applicant) who will have keys and respond within
30 minutes to an alarm activation to assist the police in determining the cause of the alarm activation
and to secure the premises (if no one within 30 minutes has a key, list someone who could help us get in touch with you).
1. Name
Day Telephone ( ) Night Telephone ( )
2. Name
Day Telephone ( ) Night Telephone ( )
City of Des Moines Ordinance 1360 requires all businesses and residences with burglary alarm systems to have a
valid alarm registration. Failure to complete this application, or to pay your $25 fee could result in NO POLICE
RESPONSE to your alarm system, and/or a penalty of $200.
Registration of an alarm system is not intended to, nor will it, create a contract, duty or obligation, either expressed or implied, of response by
the City of Des Moines Police Department. Any and all liability and consequential damage resulting from failure to respond to a notification is
hereby disclaimed and governmental immunity as provided by law is retained. By registering an alarm system, the alarm user acknowledges that po-
lice response may be based on many factors, including but not limited to availability of police units, priority of calls, weather conditions, traffic
conditions, emergency conditions, and staffing levels.
Signature
Help Prevent False Alarms
Home #
Cell #
Make checks payable to City of Des Moines
Mail to: Des Moines Police Department
21900 - 11TH AVENUE SOUTH
DES MOINES, WA 98198-6319
Des Moines Police Department
21900 - 11TH AVENUE SOUTH
DES MOINES, WA 98198-6319
(206) 878-3301
E-mail Address
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