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Occupancy / Alarm Information (Print Only)

  1. Alarm Type
  2. (If a business)
  3. (If a business)
  4. Are there Firearms on premises?
  5. Is there a safe on premises?
  6. In Case of Emergency - Contact Information
    Please list in order to call
  7. If Alarm is Activated - Contact Information
    Fill in only if different than above contacts
    Riverside Police Department will make every reasonable attempt to notify the above of an alarm activation, however, the Village is not required to notify anyone and failure to do so does not provide the alarm user any recourse. Further, the owner/occupant is responsible to maintain the accuracy of this information at all times. Complete form in its entirety. IF you have a security system, attach the annual $60.00 fee (pay: VILLAGE OF RIVERSIDE)
  9. Electronic Signature Agreement
    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.
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