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I understand that, in accordance with City Code Section XX-999, applicant is financially responsible for all charges and penalties specific in this section. 30 15 10440 540 Field42

Signature ________________________________ Date _________ 4245 525 6270 270 Field43

NOTE: If information provided in application changes, you must notify the Security Alarm Enforcement Section within ten (10) working days. Attach your check, made payable to the City of XXXX, for $15.00 non-refundable application fee and mail or deliver to: 810 10545 465 Times New Roman 8.25 Field31

Anytown, USA 12345 675 1830 2160 255 Field22

INSTRUCTIONS: Print legibly or type. Complete all application items. Complete a separate application for each address to be permitted. Attach payment and return to the address shown at the bottom of this form 1170 90 9270 630 Times New Roman 9.75 Field23

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I understand that, in accordance with City Code Section XX-999, applicant is financially responsible for all charges and penalties specific in this section. 30 15 10440 540 Field42

Signature ________________________________ Date _________ 4245 525 6270 270 Field43

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