Resident Information - Selden Fire District

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Resident Information

Indicates Required Field

Owner/Renter Name:
Address:
Apartment/Suite:
City:
Cross Street (s):
Home Phone:
Cell Phone:

Neighbor with a Key ----- See Information at the bottom of this form!!!

Neighbor with a Key Name:
Neighbor with a Key Phone:
Email Address:
I would you like to hear about Fire Department events and fundraisers via email:		Yes No
Emergency Contact Name:
Emergency Contact Phone:
Number of Adult Occupants:
Number of Child Occupants:
Special Needs Occupants:		Yes No
Special Needs Considerations:		Wheel Chair Crutches Oxygen Bedridden Mental/Developmental Disorder Other
Other Special Needs Description :
Structure Type:		One Story Two Story More than two
Basement:		No Yes - With Stairs both inside and outside Yes - Stairs only outside Yes - Stairs only inside
Garage:		None Attached Stand Alone

UTILITIES

Natural Gas:		Yes No
LP Gas/Propane:		Yes No
Water Main Shutoff Location:
Electrical Panel Location:
Any Hazardous Materials (Type and Location):
Do you have Solar Panels?:		Yes No

During an alarm phoned in by your alarm company or neighbor when you're not home, it is usually necessary for the Selden Fire Department to gain entry into your house to verify the condition.


Gaining access to your home is easiest with a key. If there is someone who has a key to your home that we can readily contact, this will result in less of a problem during an alarm.

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www.FirehouseSolutions.com	Selden Fire District 44 Woodmere Place Selden, NY 11784	Emergency Dial 911 Non-Emergency: 631-732-5570 E-mail: info@seldenfd.org