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2. Individual Permit For

   1. Apartment
   2. Duplex
   3. Home
   4. Mobile
4. Type

   1. New
   2. Renewal
6. Street Address to Be Permitted
8. Apartment Number
9. Zip
11. Applicant's Full Name
13. Date of Birth
    Date of Birth
14. Home Phone
16. Home Address (If Different from Permit Address)
18. City & State
19. Zip
20. Date Moved to Permit Address
    Date Moved to Permit Address
22. Billing Address (If Different from Permit Address)
24. City & State
25. Zip
26. Email
28. Note: All correspondence will be mailed to the billing address.
32. Name of 1st Person to Contact in an Emergency
33. Primary Phone
34. Alternate Phone
36. Name of Person to Contact in an Emergency
37. Primary Phone
38. Alternate Phone
40. Name of Person to Contact in an Emergency
41. Primary Phone
42. Alternate Phone
46. Alarm Company Name
47. Phone
49. Address (Include City & Zip)
53. Inside Pets (Number & Type)
54. Outside Pets (Number & Type)
56. Any Other Pertinent Information About the Location
60. Confidentiality
    Alarm system locations, types of systems, and the names of occupants at permitted locations are confidential information. The Police Department cannot disclose this information to others . See Section 1702.284 of the Texas Occupations Code for further information.
64. The information contained in this application is true and correct as of the date of this application. I will inform the Police Department promptly of any changes. I shall comply will all provisions of the Alarms Chapter of the Code of the City of Glenn Heights and all applicable laws of the State of Texas.
66. Applicant's Name
67. Date Signed
    Date Signed
Leave This Blank:


69. 1. Receive an email copy of this form.
70. Email address

    This field is not part of the form submission.

71. Submit

* indicates a required field