Business / Residential Key Holder Information

Business / Residential Key Holder Registry

This information will be shared with the McKean County 911 center to be added to the dispatch CAD system for emergency personnel notification and response
Emergency Key Holder Information:
Business / Residence Name *
Address *

Street Address

Street Address Line 2

City State

Zip Code
Owner Name *
Email *
Home Phone *
Cell Phone *
________________________________________________________________________________ Key Holders (List in Contact Order):
Name *
Home Phone *
Cell Phone *
Name
Home Phone
Cell Phone
Name
Home Phone
Cell Phone
Alarm Company Information:
Name
Phone Number
Building Information:
Approx. Age of the Structure
Electrical Panel Location *
Basement, garage, etc.
Natural Gas Meter Location *
Outside left corner, basement, etc.
Other information:
Does Your Business Have a Knox Box: *

Yes No N/A
_______________________________________________________________________________ To help us locate your address quickly, please provide names and addresses of your nearest neighbors (From your house / business looking toward the road)
Name & Address on Left
Name & Address on Right
Name & Address Across the Road
_________________________________________________________________________________ Structure Information:
Type of Structure:

Single Family Duplex Apartment Mobile Home Business Other
Other: Explain
Number of Floors Above Ground *
1,2,3.etc.
Do You Have a Reflective Address Sign:

Yes No
Type of Outside Covering:

Wood Stone Vinyl Brick
Other: Explain
Outside Color
Please list any information that would be helpful to emergency personnel
Should be Empty:

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Business / Residential Key Holder Registry