Mobile Home Smoke/CO Detector Compliance Affidavit

Property Address:
City:
State:
Zip Code:
Owner Name(s):

Certification

I/we, the undersigned, certify that the above-referenced mobile home is equipped with operational smoke detectors and carbon monoxide detectors installed in compliance with state and local regulations.

Number of Smoke Detectors installed:
Number of CO Detectors installed:
Date of Installation/Testing:
Installer Name (if not owner):

I/we acknowledge that installation and maintenance of functional smoke and carbon monoxide detectors is required by law and affirm that the devices have been tested and are operational as of the date below.

Owner Signature:

Date:

Owner Signature (if applicable):

Date:

Note: This affidavit may be required for transfer of ownership, inspection, or occupancy of the mobile home.