DIVISION OF SUPPORT SERVICES
All Alarm User Licenses are valid for one (1) year.
Permit Information
Any information changes must be submitted to our office within ten (10) business days.
Occupant Name or Business Name
Date of Birth
Suite/Apt#
Phone Number(s)
Address
City
State Zip
2
Billing Information
3
Same as Permit Information above
Name--If the same information, simply check the box above.
Installed by (if known)
Address
Suite/Apt#
Monitored by
Alarm System Type (Select All that Apply):
Audible Silent
Video
City
State Zip
Phone
5
Name
Signature
I understand that, in accordance with City Code, Chapter 597, I am financially responsible for all charges and penalties specific in this section.
I further accept my obligation to properly and responsibly use the alarm system at the above referenced address.
Signature
Date
State
Driver's License or State ID Number
Businesses use Federal ID Number
Printed Name/ Title, if applicable
Any payment arrangements must be approved in writing by the Division of Support Services.
Alarm Permits may not be issued or may be revoked due to past due balances
or due to multiple false alarms, in accordance with City Code, Chapter 597.
Include check or money order made payable to
City of Columbus Treasurer
Mailing/Office Address:
Department of Public Safety
Division of Support Services
4252 Groves Rd
Columbus, OH 43232
OFFICE USE ONLY
Account # _______________
Exp. Date _______________
Payment Info _____________
POLICE ALARM USER APPLICATION
Chapter 597, Columbus City Codes
Apply on-line https://product.cityalarmpermit.com/FAMSCITIZEN/columbus/
OR use this application to apply through the mail or in person.
Phone 614-645-7960 Email alarms@columbus.gov fax 614-645-8912
On-Line Portal https://product.cityalarmpermit.com/FAMSCITIZEN/columbus/
Contact Information (Alternate Keyholder in case of an Emergency)
Email - If provided, will be used as a contact
Alarm Information
If Permit Holder is different than the Permit Information, Check Box.
4
1
Special Conditions (Medical/Pet Information): _________________________________
______________________________________________________________________________
______________________________________
Office Hours: M-F 8:00 a.m. to 3:30 p.m.
