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2. 
3. FRANKLIN COUNTY PUBLIC SAFETY WANTS TO ENSURE THAT EVERY HOME IN THE COUNTY HAS A WORKING SMOKE DETECTOR. IF YOU, A NEIGHBOR, OR FAMILY MEMBERS ARE WITHOUT SMOKE DETECTORS IN YOUR HOME AND ARE A FRANKLIN COUNTY VA RESIDENT, COMPLETE THE SMOKE DETECTOR INSTALLATION FORM BELOW. WE WILL INSTALL THEM IN THE APPROPRIATE AREAS OF YOUR HOME FREE OF CHARGE.
5. Date*
   Date
6. Name *
7. Street Address*
9. City*
10. State*
11. Zip*
13. Phone Number *
15. Office Use Only
    Please do not fill out beyond this point. Franklin County Department of Public Safety will require the resident's signature and date when the install is completed.
17. Occupant Signature
    
    
    ______________________________________________
19. Occupant Printed Name
    
    
    ______________________________________________
21. Installation Date
    
    
    __________________________
23. Number of Alarms Installed
    
    
    ______________________________________________
25. Installer Signature
    
    
    ______________________________________________
27. Installer Printed Name
    
    
    ______________________________________________
29. Franklin County Department of Public Safety
    1488 Franklin Street
    Rocky Mount, VA 24151
    PHONE: 540-483-3091 • FAX: 540-483-3086
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