2. Type of Registration*

   1. New Registration
   2. Renewal / Change of Information
   3. Cancellation
4. Alarm User Information
6. Name of Applicant(s) (Resident(s), Business)*
7. Phone Number(s)*
9. Address*
   (Include Building Number, Suite Number, Apartment Number)
11. City*
12. State
13. Zip Code
15. Mailing Address (If different from above), include Building Number, Suite Number, Apartment Number
17. City
18. State
19. Zip Code
23. Emergency Contacts
25. Name*
26. Phone Number*
28. Name
29. Phone Number
31. Name
32. Phone Number
36. Alarm Information (Monitoring Company)
38. Alarm Company Name
39. Phone Number
41. Notes:
43. Please read Article 41 of the Town of Hingham By-Laws and sign below.
    Town of Hingham By-Laws
45. 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.

    1. I agree.
47. Electronic Signature*
48. Date
    Date
50. Email Address*
52. NOTE:
    All Alarm Systems shall be registered with the police department. Failure to register annually shall subject the alarm user to a fine of $50. The registrant is responsible for notification of any changes to the registration. You do not need to re-register annually, only notify us if there are any changes or you are cancelling your permit. You must register your alarm even if your system is not monitored by a monitoring company.
Leave This Blank:


54. 1. Receive an email copy of this form.
55. Email address

    This field is not part of the form submission.

56. Submit Submit and Print

* indicates a required field