< Safe Housing Application

Property Information

Contractor(s)

Fees: (Please enter the amount)

Discounts: (Please enter the amount)

Total Amount Due: (Fees minus Discounts):

To receive your discount, you must include the following documentation with your registration form:

Sprinkled Building: include a testing report, maintenance report, or maintenance contract Central Alarm System: Fire Department log or alarm contract Federally Funded Unit: Copy of a passed UPCS or HQS report dated within one year

I hereby certify under penalty of perjury that the statements made in this application are true and correct to the best of my knowledge and belief.

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