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2. **To Be Completed By Business or Organizational Representative**
4. I understand the service fee is not voided by filling out this form.
5. Complainant Initial Here:
7. Please check the box below to indicate which violation you are contesting:

   1. Alarm Activation (Non-Registered Alarm Business/Commercial $100.00)
   2. Alarm Activation (5th Activation $50.00)
   3. Alarm Activation (6th Activation $100.00)
   4. Alarm Activation (7th or Subsequent $150.00)
9. Date And Time of Activation:
11. Location Where Activation Occured:
13. Name of Representative:
15. Address:
17. Mailing Address (If Different):
19. Telephone:
21. Please indicate below the reason for contesting this violation:
Leave This Blank:


23. 1. Receive an email copy of this form.
24. Email address

    This field is not part of the form submission.

25. Submit

* indicates a required field