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Home My WebLink About820 Windtree Ctr RECEIVED OCT 24 2011 CITY OF SANFORD BY: BUILDING & FIRE PREVENTION w PERMIT APPLICATION Application No: �L/ Documented Construction Value: $ -19 - 00 � Q \ pforc) , Fl_ 3 a1 13 Job Address: O a O ��J ,ak(e2 ca. a r1 } '9D.06 Historic District: Yes ❑ No 0 Parcel ID: 0 a - ao - 30 - 300 •0-bi 0 - 0000 Zoning: Description of Work: Plan Review Contact Person: Phone: Fax: Title: E-mail: Property Owner Information Name -T1a Q J�; Street: -0 Clam City, State Zip: amps. FL 33 0-a 1 JI Phone: Resident of property? : Contractor Information Name AID T Street: Guo S1\cAAo� f�C�.a4 �C C. al l City, State Zip:C��1� Name: Street: City, St, Zip: Bonding Company: Phone: 14o l- 316- 3 a l 3 Fax: State License No.: 'E F 00011 a 1 Architect/Engineer Information Phone: Fax: E-mail: Mortgage Lender: Address: Address: PERMIT INFORMATION Building Permit 0 Square Footage: No Construction Type: No. of Stories: No. of Dwelling Units: Flood Zone: Electrical New Service - No. of AMPS: Mechanical D (Duct layout required for new systems) Plumbing O New Construction - No. of Fixtures: Fire Sprinkler/Alarm O No. of heads: Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that nc work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for electrical work, plumbing, signs, wells, pools, furnaces, boilers, heaters, tanks, and air conditioners, etc. OWNER'S AFFIDAVIT: I certify that all of the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT. NOTICE: In addition to the requirements of this permit, there may be additional restrictions applicable to this property that may be found in the public records of this county, and there may be additional permits required from other governmental entities such as water management districts, state agencies, or federal agencies. Acceptance of permit is verification that I will notify the owner of the property of the requirements of Florida Lien Law, FS 713. The City of Sanford requires payment. of a plan review fee. A copy of the executed contract is required in order to calculate a plan review charge. If the executed contract is not submitted, we reserve the right to calculate the plan review fee based on past permit activity levels. Should calculated charges exceed the documented construction value when the executed contract is submitted, credit will be applied to your permit fees when the permit is released. Signature of Owner/Agent Date Owner/Agent's Name Signature of Co ctor/Agent Date Qi '1 Print Contractor/ gent's Name O (� Signature of Notary -Slate of Florida Date Signature ofof Fi FA ISSION A EE 1 tr ' EXPIRES: August 2, 2015 ly, • Bonded Tluu Notary Public Underwriters Owner/Agent is Personally Known to Me or Contractor/Agent is Personally Known to Me or Produced ID Type of ID Produced ID Type of ID APPROVALS: ZONING: UTILITIES: WASTE WATER: ENGINEERING: FIRE: BUILDING: COMMENTS: Rev 11.08 POWER OF ATTORNEY Date: 10/0L)/x'311 T hereby name and appoint I 1 Of l�- of ADT Security Services to drop off and pick up permits at the Building Department on my behalf for a LOVr VOLTA G SECURI'T'Y permit for work to be performed at a location d -.;•cnbed as: Parcel 0a —010 - 30 - 300 - 0 3l D - 0CX00 Subdivision ► f\G r !� �� Address of job 9 a p 1�� 1 c -,k( Q e- Q+ • SQ f 1 a(A . EL 3a-1 3 Owner T W C M ►1\ Q�A — q� J e- LT 1_ George MangineIli EF0001 21 Type or Fant Name of Certified Contractor Sign ,;eACWMird Contractor The foregoing instrument was acknowledged before me this 0 / of 1 day of 20 f by who is pers ally wn to me/wh roduced as identifimffon and who did not take oath. State of Florida County of 17 LAUREN r EXPIRES: IN, EE Au usl 2, 2015 Notary Public, Se inole County, Florida irrta,, (1�daaThmNotaryPPubkundeiw*13 Seminole County Property Appraiser Get Information by Parcel Number Page 1 of 2 Personal Property I Please Select Account zi G [2E TAIL DAvlo JOHNSDN, CFA. ASA PROPERTY 1 APPRAISER 5EP41NOLE COUNTY FL ' 1101 E. FIRST ST SANFORD. vL 32771./ 46B 407 -ABB -7506 t VALUE SUMMARY VALUES 2011 2010 Working Certified Value Method Income Income GENERAL Number of Buildings 17 17 Parcel Id: 02-20-30-300.031D-0000 Depreciated Bldg Value $0 $0 Owner: TWC NINETY-FIVE LTD Depreciated EXFT Value $0 $0 Mailing Address: 655 N FRANKLIN ST #2200 Land Value (Market) $0 $0 City,State,ZlpCode: TAMPA FL 33602 Land Value Ag $0 $0 Property Address: 2675 25TH ST W SANFORD 32771 Just/Market Value 37,650,772' $8,195,959' Facility Name: WNDCHASE Portabllty Ad) 1 $0 $0 Tax District: St-SANFORD Save Our Homes Ad) $0 $0 Exemptions: Amendment 1 Ad) $0 $0 Dor: 03 -MULTI FAMILY 10 OR M Assessed Value (SOH) $7,650,772 ' $8.195,858 Tax Estimator (• Income Approach used.) 2011 TAXABLE VALUE WORKING ESTIMATE Taxing Authority Assessment Value Exempt Values Taxable Value County General Fund $7,650,772 $0 $7,650,772 (Amendment 1 adjustment is not applicable to school assessment) Schools $7,650,772 $0 $7,650,772 City Sanford $7,650,772 $0 $7.650,772 SJWM(Salnt Johns Water Management) $7,650,772 $0 $7,650,772 County Bonds $7,650,772 $0 $7.650,772 The taxable values and taxes are calculated using the current years working values and the prior years approved millage rates. SALES 2010 VALUE SUMMARY Deed Date Book Page Amount Vac/Imp Qualified 2010 Tax Bill Amount: $164,631 WARRANTY DEED 06/1987 03256 0142 $2,000.000 Vacant No 2.010 Certlfied Taxable Yalue_amd Tax@g Find Sales within this DOR Code DOES NOT INCLUDE NON -AD VALOREM ASSESSMENTS LEGAL DESCRIPTION SEC 2 TWP 20S RGE 30E BEG 666.6 FT S & 50 FT E OF NW COR RUN E 792.44 FT N 45 DEG 7 MIN 41 SEC E 19 04 FT N 187.02 FT N 12 DEG 37 MIN 23 SEC E 88.27 FT N 182.73 LAND FT N 9 DEG 16 MIN 6 SEC W 107.13 FT N 46 DEG 43 MIN 57 SEC W 58.76 FT TO SLY E 146.18 FTS 625.24 E Land Assess Method Frontage Depth Land Units Unit Price Land Value 9 D 327.38 FT SLY 8 SWLY ALONG OLD LAKE MARY RDD LOT 0 0 352.000 5,000.00 $1,760,000 1185.46 FT N 47 DEG 27 SEC W 96.73 FT NWLY ALONG CURVE 70.03 FT N 26 DEG 57 MIN 46 SEC W 65.8 FT N 60 DEG 32 MIN 14 SEC E 3 FT N 26 DEG 57 MIN 46 SEC W 372.19 FT S 63 DEG 2 MIN 14 SEC W 141 92 FT S 26 DEG 57 MIN 46 SEC E 2 FT WLY 431.17 FT TO ELY R/W N 324.15 FT E 10 FT N 359.17 FT TO BEG BUILDING INFORMATION Bid Num Bid Class Year Bit Fixtures Gross SF Stories Ext Wall Bid Value Est. Cost New 1 MULTIFAMILY 1998 120 22,158 WOOD SIDING WITH WOOD OR METAL STUDS $1,175,460 $1,234,079 Subsection I Sqft OPEN PORCH FINISHED/ 594 2 MULTIFAMILY 1998 144 32,848 3 WOOD SIDING WITH WOOD OR METAL STUDS $1,674,698 $1,758.213 Subsection / Sgft OPEN PORCH FINISHED / 2460 3 MULTIFAMILY 1998 144 32,948 3 WOOD SIDING WITH WOOD OR METAL STUDS $1,670,304 $1,753,600 Subsection / Sgft OPEN PORCH FINISHED / 2460 http://www.scpafl.org/web/re_web.seminole_county_title?parcel=022030300031 D0000&... 10/21/2011 Seminole County Property Appraiser Get Information by Parcel Number Page 2 of 2 4 MULTIFAMILY 1998 72 17,568 3 WOOD SIDING WITH WOOD OR METAL STUDS $1,011,494 $1,061,936 Subsection I SqR OPEN PORCH FINISHED / 3336 Units EXFT Value Est. Cost New 5 MULTIFAMILY 1998 120 22,158 3 WOOD SIDING WITH WOOD OR METAL STUDS $1,175,460 $1,234,079 Subsection / SqR OPEN PORCH FINISHED / 594 3,876 $8,660 6 MULTIFAMILY 1998 72 17,568 3 WOOD SIDING WITH WOOD OR METAL STUDS $1,006,975 $1,057,192 Subsection I SqR OPEN PORCH FINISHED / 3336 POLE LIGHT CONCRETE 1 ARM 1998 7 MULTIFAMILY 1998 120 22,158 3 WOOD SIDING WITH WOOD OR METAL STUDS $1,175,460 $1,234,079 Subsection I SqR OPEN PORCH FINISHED / 594 $3,200 $3,200 8 MULTIFAMILY 1998 120 22,158 3 WOOD SIDING WITH WOOD OR METAL STUDS $1,175,709 $1,234,340 Subsection I SqR OPEN PORCH FINISHED / 594 1998 42 9 MULTIFAMILY 1998 120 22,158 3 WOOD SIDING WITH WOOD OR METAL STUDS $1,175,460 $1,234,079 Subsection / SqR OPEN PORCH FINISHED / 594 $20,160 SPA 10 MULTIFAMILY 1998 120 22,158 3 WOOD SIDING WITH WOOD OR METAL STUDS $1,175,460 $1,234,079 Subsection / SqR OPEN PORCH FINISHED 1594 1 $3,375 11 MULTIFAMILY 1998 72 17,568 3 WOOD SIDING WITH WOOD OR METAL STUDS $1,008,537 $1,058,831 Subsection / SqR OPEN PORCH FINISHED / 3336 12 MULTIFAMILY 1998 120 22,158 3 WOOD SIDING WITH WOOD OR METAL STUDS $1,175,460 $1,234,079 Subsection / SqR OPEN PORCH FINISHED / 594 13 MULTIFAMILY 1998 144 32,948 3 WOOD SIDING WITH WOOD OR METAL STUDS $1,670,304 $1,753,600 Subsection / SqR OPEN PORCH FINISHED / 2460 14 MULTIFAMILY 1998 120 22,158 3 WOOD SIDING WITH WOOD OR METAL STUDS $1,175,460 $1,234,079 Subsection / SqR OPEN PORCH FINISHED / 594 15 MULTIFAMILY 1998 144 32,948 3 WOOD SIDING WITH WOOD OR METAL STUDS $1,670,304 $1,753,600 Subsection / SqR OPEN PORCH FINISHED/ 2460 16 MULTIFAMILY 1998 144 32,948 3 WOOD SIDING WITH WOOD OR METAL STUDS $1,670,304 $1,753,600 Subsection I SqR OPEN PORCH FINISHED / 2460 17 WOOD BEAM/COL 1998 19 4,765 1 WOOD SIDING WITH WOOD OR METAL STUDS $355,859 $424,906 Subsection I SqR OPEN PORCH FINISHED/ 1992 Permits NOTE: Assessed values shown are NOT certified values and therefore are subject to change before being finalized for ad valorem tax purposes "' If you recently purchased a homesteaded orooerty vour next vear's oropertv tax will be based on Just(Market value. hnp://www.scpafl.org/web/re_web.seminole_county_title?parcel=022030300031 D0000&... 10/21/2011 EXTRA FEATURE Description Year Bit Units EXFT Value Est. Cost New COMMERCIAL ASPHALT DR 2 IN 1998 260,480 $160,000 $237,037 WALKS CONC COMM 1998 3,876 $8,660 $12,830 STUCCO WALL 1998 17,712 $47,822 $70,848 POLE LIGHT CONCRETE 1 ARM 1998 34 $35,292 $35,292 OVERRIDE 1998 1,600 $3,200 $3,200 STUCCO WALL 1998 675 $1,823 $2,700 WOOD UTILITY BLDG 1998 42 $161 $336 POOL COMMERCIAL 1998 720 $13,608 $20,160 SPA 1998 1 $3,119 $5,500 WATER FEATURE 1998 1 $3,375 $5,000 NOTE: Assessed values shown are NOT certified values and therefore are subject to change before being finalized for ad valorem tax purposes "' If you recently purchased a homesteaded orooerty vour next vear's oropertv tax will be based on Just(Market value. hnp://www.scpafl.org/web/re_web.seminole_county_title?parcel=022030300031 D0000&... 10/21/2011 RESIDENTIAL SERVICES CONTRACT ILL IIU91111dIIN�II CONTRDATE ACT �� / / CUSTOMER NO f ' JNO SOU CE ADT Security Services, Inc. ("ADT") Customer Name Office Address ('Customer' or 'I' or 'me" or 'my') 1 www.MyADT.com 1.800.ADT.ASAP® (1.800.238.2727) E -j State L -..LJ ZIP LL Tax Exempt No. Protected Premises' Mllsr Telephone Tax Expire Date (V'pTraditional Phone O Other (Qualified) O Other (Non -Qualified) AlternateTF M Telephone 1 % O Home CPCell O Work IF FAMILIARIZATION PERIOD IS Alternate REJECTED INITIAL HERE Telephone 2 11 1 H I I I I IFFMO Home O Cell.. O Work (see Paragraph 14 of the Terms and Conditions for explanation) EMAIL Communications Authorization: I authorize ADT to provide me with information and updates about the security system and new ADT and third -party products and services to the contact information provided by me. I may unsubscribe or opt out by emailing donotcontactOADT.com or by calling 888.DNC4ADT (888.362.4238). Initial here Confirmation of Appointments: I authorize ADT to call me using an automated calling device to deliver a pre-recorded message to set/confirm appointments and provide other information and notices about the alarm system at the telephone number(s) provided by me. Initial here Alarm System Ownership: O Customer -Owned ®ADT -Owned I ACKNOWLEDGE AND AGREE TO EACH OF THE FOLLOWING: (A) THIS CONTRACT CONSISTS OF SIX (6) PAGES. BEFORE SIGNING THIS CONTRACT, I HAVE READ, UNDERSTAND AND AGREE TO EACH AND EVERY TERM OF THIS CONTRACT, INCLUDING BUT NOT LIMITED TO PARAGRAPHS 5 AND 18 OF THE TERMS AND CONDITIONS. (B) THE INITIAL TERM OF THIS CONTRACT IS THREE (3) YEARS. (C) ADT IS NOT A SECURITY. CONSULTANT AND CANNOT ADDRESS ALL OF MY POTENTIAL SECURITY NEEDS. ADT HAS EXPLAINED TO ME THE FULL RANGE OF EQUIPMENT AND SERVICES THAT ADT CAN PROVIDE ME. ADDITIONAL -EQUIPMENT -AND SERVICES OVER THOSE IDENTIFIED IN THIS CONTRACT ARE AVAILABLE AND MAY BE PURCHASED FROM ADT AT AN ADDITIONAL COST TO ME. I HAVE SELECTED AND PURCHASED ONLY THE EQUIPMENT AND SERVICES IDENTIFIED IN THIS CONTRACT. (D) NO ALARM SYSTEM CAN PROVIDE COMPLETE PROTECTION OR GUARANTEE PREVENTION OF LOSS OR INJURY. FIRES, FLOODS, BURGLARIES, ROBBERIES, MEDICAL PROBLEMS AND OTHER INCIDENTS ARE UNPREDICTABLE AND CANNOT ALWAYS BE DETECTED OR PREVENTED BY AN ALARM SYSTEM. HUMAN ERROR IS ALWAYS POSSIBLE, AND THE RESPONSE TIME OF POLICE, FIRE AND MEDICAL EMERGENCY PERSONNEL IS OUTSIDE THE CONTROL OF ADT. ADT MAY NOT RECEIVE ALARM SIGNALS IF COMMUNICATIONS OR POWER IS INTERRUPTED FOR ANY REASON. (E) ADT RECOMMENDS THAT I MANUALLY TEST THE ALARM SYSTEM MONTHLY AND ANY TIME 1 CHANGE TELEPHONE SERVICE, BY CALLING 1.800.ADT.ASAP OR BY LOGGING IN TO WWW.MYADT.COM. (F) THIS CONTRACT REQUIRES FINAL APPROVAL BY AN ADT AUTHORIZED MANAGER BEFORE ADT MAY PROVIDE ANY EQUIPMENT OR SERVICES, AND IF APPROVAL IS DENIED, THEN THIS CONTRACT WILL BE TERMINATED, AND ADT'S ONLY OBLIGATION WILL BE TO NOTIFY ME OF SUCH TERMINATION AND REFUND ANY AMOUNTS I PAID IN ADVANCE. ADT Representative Name Af Rep. License No. (If Required) Approval: Or `g1 al Signature Required (Must match Customer Name in Section 1 above) � Rep. 1 / P ID No. V U NOTICE OF CANCELLATION I, THE CUSTOMER, MAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO. MIDNIGHT OF THE THIRD BUSINESS DAY AFTER THE DATE OF THIS TRANSACTION. SEE THE ATTACHED NOTICE OF CANCELLATION FORM FOR AN EXPLANATION OF THIS RIGHT. I ACKNOWLEDGE BEING VERBALLY INFORMED OF MY RIGHT TO CANCEL AT THE TIME OF EXECUTION OF THIS CONTRACT AND RECEIPT OF THIS NOTICE. FINANCIAL DISCLOSURE STATEMENT THERE IS NO FINANCE CHARGE OR COST OF CREDIT (0% APR) ASSOCIATED WITH THIS CONTRACT. A. NUMBER OF PAYMENTS FOR THE B. AMOUNT OF EACH PAYMENT IS TOTAL OF PAYMENTS FOR THE INITIAL TERM IS $ INITIAL TERM IS 36. (TOTAL MONTHLY SERVICE CHARGE FROM BLOW) (A. TIMES B.) (EXCLUSIVE OF.ANY APPLICABLE TAXES, FEES, FINES AND RATE INCREASES) LATE CHARGE - PAYMENT IS DUE PURSUANT TO MY SELECTED BILLING I ENT - IF I PREPAY THE SEE SECTIONS 2, 7, 15 AND FREQUENCY, PRIOR TO THE START OF SERVICE. MY FIRST BILUCHARGE WILL PREPAYM I TOTAL M PAYMENTS PRIOR HEjSE S THIS CONTRACT FOR BE SENT/MADE SHORTLY AFTER MY SERVICE BEGINS. ADT MAY IMPOSE A M ADDITIONAL INFORMATION ONE-TIME LATE CHARGE ON EACH PAYMENT THAT IS MORE THAN TEN (10) THE END OF THE INITIAL TER i OF THIS CONTRACT, THERE R NO ! ABOUT NONPAYMENT, DEFAULT DAYS••PAST'DUE, UP TO.THE MAXIMUM AMOUNT PERMITTED BY LAW, BUT IN PENALTY OR REFUND. AND ACCELERATION.! NO EVENT WILL THIS AMOUNT EXCEED $5.00. i 1 Of 6 Administrative Copy 02011 ADT. All rights reserved (0411) RESIDENTIAL SERVICES CONTRACT � I IIIIII VIII VIII VIII IIII IIIIIII IIII 5104UEl2 CONTRACT CUSTOMER DA E b ACCOUNT NO �" L + " �NO SOURCE Monthly Service Charge O Initial/Annual Recurring Municipal Fee billed separately I Initial/Annual Fee WStandard Monthly Service, Burglary (Subject to change based on local law) Service includes: Customer Monitoring Center Signal O Customer to obtain and pay for initial/annual municipal Receiving and Notification Service for Burglary, alarm use permit. Failure•to,obtain,and,provide ADT with Manual Fire and Manual Police Emergency $ /J �J q9 the municipal alarm use permii registration number could result in no municipal firelpolice response'to an alarm from the premises and/or'a fine. O Standard Monthly Service, Fire/Smoke Detection Service includes: Customer Monitoring Center Signal Municipal Electrical Permit Fee $ F q Receiving and Notification Seivice•for Fire.' Manual. Fire O Customer to'obtain electrical permit and Manual Police Emergency O Carbon Monoxide O Flood O Low Temp $ Installation Price $ 9GI O Medical Alert Taxable -Amount O Safewatch.Cellguard• $ Non -Taxable Amount $ O SecurityLink• $ Connection Fee $ ® Extended Limited Warranty/Quality Service Plan (QSP) $ / AI C Admin•Fee $ O Guard'Response Service$ Sales Tax on Installation* $ T,iQ O Other $ Deposit Received $ Total Monthly Service Charge $ 471/ Balance Due upon Installation* $ q —/ *If applicable sales tax not shown, it will be added to the first invoice. Section• • • •' Installed 1 ta• � ContrWe SS�Panel— rQa� S¢o °� o°O L�Q°� Ste° c� oa`°� ¢� La qv -,9 Qo�s oS J\S. sc Jas c� K�°i'a�� Comments Package Name: t Includes: Foyer Living Room Family Room Office Dining Room i Kitchen Laundry -Room i ' Hallway ! Master Bedroom Master Bath Bedroom 2 i • Bedroom 3 f' 'B""2,- s Basement Garage MO ",I � I V 1 f• 1 • "'I Totals f r I I I I I I I I E= Existing Equipment /�/� Estimated Installation Start Date ®i {-1_J INSTALLER NOTES .& 2 of 6 ---•Uu �s% �1J X11 02011 ADT. All rights reserved. (04/11) nRESIDENTIAL SERVICES CONTRACT 1111116114UN2N�tl CON RAcTDATE l 1—L`l� W * CUSTOMER LEAD ACCOUNT NO Z JNO SOURCE C. Section Billing O Ch4. eck received for. O Installation: Check # Amount -]7n O Annual Service Charges Collected: Check #, Amount I authorize ADT: O To withdraw all Service Charges from. my bank account: OD To charge my credit/debit card for: O Annually O Semi -Annually O Quarterly O Monthly O Installation O 3 monthly credit/debit card payments of equal amounts Choose one: O Checking O Savings (available only for telephone orders with an installation price over $400 or field sales with an installation price over $1,500) Name of Bank/Credit Union 4W All/Recurring Service Charges O Annually O Semi -Annually O Quarterly ® Monthly P7_9 ABA Routing Number Bank Account Number Q VISA O MasterCard O Discover O AMEX Credit/Debit Card Number Expiration Date • 20 MAE Recurring Service Charge Amount M M Y Y Name as it appears on bank account Recurring Service Charge Amount ( 9 Q Cardholder's Name I authorize ADT to debit my bank account for the amount of all Recurring Service Charges If I am using a debit card, I authorize ADT to debit my bank account for the amount of indicated above. I may revoke this authorization only by notifying ADT and my bank in all Recurring Service Charges indicated above. I may revoke this authorization only by writing at least 10 business days before the scheduled debit. notifying ADT and my bank in writing at least 10 business days before the scheduled debit. If no oval is filled above, service charges will be withdrawn monthly. If no oval is filled above, my credit/debit card will be charged monthly. I authorize ADT to withdraw the amounts in this section from my bank account or credit card through an Automated Clearing House ('ACH"). These payments are for the equipment and services described in this Contract. This authorization will remain in effect until the termination date of this Contract or until I cancel it in writing, whichever occurs first. I also agree to . notify ADT in writing of any changes in my account information'at least 15 days -prior to the next billing date. If a payment date falls on a weekend or holiday, payment may be executed on the next business day. Because this is an electronic transaction, these funds may be withdrawn from my account each month as early as the transaction date. If the date or amount of the withdrawal changes, ADT will notify me at least 10 days prior to the payment being collected. If an ACH transaction is rejected for non -sufficient funds (NSF), ADT may attempt to process the charge again within 30 days, and an NSF charge may apply. The origination of ACH transactions to my account must comply with the provisions of U.S. law. I am an authorized user of this credit card or bank account, and I will not dispute the payment with my credit card company or bank, so long as the amount corresponds to the terms indicated in this Contract. O To send me a bill: O Annually O Semi•An ually O Quarterly " O Other DOA Approval If no oval is filled, ADT will send bill quarterly. Authorized Account Signature: Section• and System Data 1,ALL Al 14iS 00�U Name CS # l T d E C r Address 6 G U r A v U EE ZIP Cross St. City State �! D 2 S 7 n r Premises' Phone #1 Phone #2 O Cell Only Municipality�I Municipality Police Name Fire Name Municipality Patrol Name Medical Number & Number Job Type 0 New Sale O Change Over O Upar?ds Control Type O HW O RF Permit Affiliation Member # Number Burglar Alarm: ® Yes O No Fire / Smoke: O Yes Q No Two -Way Voice: O Yes p No Cellular Model: O Parallel O Standard Preferred Monitoring Communication Account Management ProfileEl. ® M M E2 � Codes: Ownership System Service Services Method Services Guard Market Resale -Former M Od III I ELW/QSP Service Group Acct # Former CS # Section• Password This password must be issued to all users of the alarm system, including all people listed in Section 7. An optional, secondary password for service individuals, housekeepers, tenants, etc. is available upon request. A password must be no less than three (3) and no more than five (5) characters in length and may not contain any punctuation or spaces, offensive language or non-standard spelling. Customer may change passwords and contacts by going to www.MyADT.com or by calling ADT toll-free at 1.800.ADT.ASAP. Section•'Contact These are the individuals who may be called in the event of an alarm. Because they may need to meet the authorities in response to an alarm, I will provide them access to my premises, the password, and the keypad code. By selecting the 'Yes' designation on the right ram identifying which of these individuals may be called prior to notification of the authorities. Customer/Emergency Contact #1 Q O O • O Print First/Last Name (-! �T ' `� Phone `1�7 zd 9,2rHome Cell Work Yes No n / 06'O �7 �'� I Phone Home Cell Work Yes No Customer/Emergency Contact #2 /J ri O 4 O O A / `� ��/na Print First/Last Name l!��E7`('," i GST— Phone Home Cell Work Yes No O O O O O Phone Home Cell Work Yes No Alternate/Emergency Only ContactuU LCom�or O p Print First/Last Name /Al,>,e.AiCC�1,01L'D/ Phone �. Home IWork Yes NoO O O 00 Phone Home Cell Work Yes No 3of6 02011 ADT. All rights reserved. (04/11)