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EL-12-1231Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 193927 Permit Number: EL -7 -12 -1231 Scheduled Inspection Date: June 20, 2013 Inspector: Devaney, Michael Owner: FRYER, ANITA Job Address: 758 NE 95 Street Miami Shores, FL Project: <NONE> Contractor: ADT LLC Permit Type: Electrical - Residential Inspection Type: Final Work Classification: Alarm Phone Number Parcel Number 1132060141890 Building Department Comments BURGLAR ALARM INSTALLATION 03/15/2013 - SAME QUALIFIER Infractio Passed Comments INSPECTOR COMMENTS False Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments, 2a June 20, 2013 For Inspections please call: (305)762 -4949 Page 34 of 40 ill wept Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 BUILDING PERMIT APPLICATION FBC 2013 Permit Type: Electrical MAR it 5 2013 Permit No. Master Permit No. /�L .7 /) - /•x3/ OWNER: Name (Fee Simple Titleholder): Phone #: Address: 7.S'8 4F 93" City: � /'/ '</ ka State: /` Zip: Tenant/Lessee Name: Phone #: Email: JOB ADDRESS: .�'e 4/6 7s' Or- City: Miami Shores County: Miami Dade Zip: Folio/Parcel #: Is the Building Historically Designated: Yes NO Flood Zone: CONTRACTOR: Company Name: y �� 1 1 L Address: /b 78r °%✓1,s-A dy °, ,, / Qualifier Name: C DJ 4 6.40 /Nel i State Certification or Registration #: ",566,1P-/ City: 404- State: Phone #: "J..0 ��-%‘ Zip: 33�s.2 -,?' Phone #: ,i:?'• .7-4(44'.5--2 Certificate of Competency #: Contact Phone#: " ?% 0:2-N Email Address: DESIGNER: Architect/Engineer: Phone #: Value of Work for this Permit: $ Square/Linear Footage of Work: Type of Work: ❑Address n OAlteratii ONew ❑Repair/Replace UDemolition Description of Work: /� -t!�!. C &� ,-L • 7-42 - /-237 *** ****** ** * ** ** x ****+x** ***x *** ****** ** Fees*********: x***** *** *****:r***** * **********x:*** Submittal Fee $ Scanning Fee $ Notary $ Double Fee $ Permit Fee $ t 00 ° OD CCF $ Radon Fee $ DBPR $ Training/Education Fee $ Technology Fee $ Structural Review $ CO /CC $ Bond $ TOTAL FEE NOW DUE $ 0 Bonding Company's Name (if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and MR CONDITIONERS, ETC OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature Owner or Agent The foregoing instrument was acknowledged before me this day of ,20_,by who is personally known to me or who has produced As identification and who did take an oath. NOTARY PUBLIC: Sign: Print: My Commission Expires: Signature Contractor The foregoing instrument was acknowledged before me this day of V , 2013, by who is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: My Co 4114, *+ x: x+ x************* *+ x*****: x* ***** *+ x: x***** **** ****** ******* * * * ******x *** APPROVED BY. /'e ,.4h Plans Examiner v:.) Structural Review (Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09) fifes: MAPlik D Ma Notary Public • State 0t F10 ?.i 0 j • Ft *5 My Comm. Expites Mai ?. fib' • Commission # EE 196J20 ** Zoning Clerk "97/SW al Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 B DING PERMIT APPLICATION Permit Type: Electrical FBC 20 IMCMINYM M JULO3Z12 BY: Permit No. L. 12-)2bJ Master Permit No. JOB ADDRESS: 7 5 U qS S.11-12-1— 1 , `le- City: Miami Shores County: Miami Dade Zip: 331 3& Folio/Parcel #: 1 t ;J2O 6 001 1 q() Is the Building Historically Designated: Yes NO Flood Zone: OWNER: Name (Fee Simple Titleholder): Ma/2/e/-et ( Phone #: Address: 700 NE Co Sii-e9, City: I9 i )97/ State: Tenant/Lessee Name: Phone #: Zip: 45 3J3? Email: CONTRACTOR: Company CompanyyName: /1/Y7 Se2cf t? � ?//TJ Phone #: Address: /DM-- /27a/1-s' (vL City: State: Qualifier Name: -e6V- , /i% 12, Phone #: /}3V!®d, State Certification��rrRyReegi``stration #: jz /10/ Certificate of Competency #: Contact Phone #(' 4) c ' ' Email Address: G4,! /'Z d efi7-"% '%1.� i / f Zi • ,� �cS� DESIGNER: Architect/Engineer: °:..P} one #: Value of Work for this Permit: $ e, c�� ®• f Square/Linear Footage of Wtirk: Type of Work: UAddress QAlteration UNew URepair/Replace Description of Work: !l ,' 7 �� /'zr1-e7// UDemolition Submittal Fee $ Permit Fee $ / ®6" ca CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ Bonding Company's Name (if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant trust promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement Hurst be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a r 'n.spection.fee will be charged. PAs cis INL Signature /Ll Owner or Agent The fore oing ' nstrument was acknowledged before me this25 day o , 20121 -, by who is personally known to me or who has produced ` G'" As • ation and who did take an oath. NOTARY PUBLIC ,I , j�w "; _Banded Thru N� My Commission Expires: Sign: g n: Print: Signature 7 Contractor The foregoing instrument was acknow.; dged before me this day of who is , 20ta, by '7 //' e sr onally known' o me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: o34viY eA k 'oh Is : Ty NDFp� �t 70 e My Commission ExpRetd 1, �gRyp 0y ° •' FR�Vjq TFRS • * * * * * * * * * * ***. *** * ** ** ** ** * * *** ** ** * ** *•*. ** ***** * * * ** *** ** * ** *** **. ***** * ****** *. **i xep Plans Examiner APPROVED BY Structural Review 112evisect 3/12/2012 1(Rcised 07/1 010 7 11IZ7viscd (WilIU /20(ri)i(Revi.c(I 3/15/119) ,3959,%.•' °'GG O ems` vvivn< TATE %% glllBlid�0,0 Zoning Clerk Miami-Dade My Home, My Home Show Me: e. [Property Information Search By: Select Item Text only Property Appraiser Tax Estimator Property Appraiser Tax Comparison Portability S.O.H. Calculator Summary Details: Folio No.: 11- 3206- 014 -1890 Property: 758 NE 95 ST Mailing ANITA FRYER [EST OF] Address: 1 Living Units: 758 NE 95 ST MIAMI FL Adj Sq Footage: 33138 -2515 Property Information: Primary Zone: 1000 SINGLE FAMILY RESIDENCE CLUC: 0001 RESIDENTIAL - SINGLE FAMILY Beds /Baths: 2/1 Floors: 1 Living Units: 1 Adj Sq Footage: 1,461 Lot Size: 12,900 SQ FT Year Built: 1948 $100,500/ $46,870 MIAMI SHORES SEC 3 Legal PB 10 -37 LOT 5 & 6 BLK Description: 67 LOT SIZE 100.000 X 129 OR 00000 -0000 $25,500/ $121,870 1171 00 Assessment Information: Year: 2011 2010 Land Value: $156,488 $195,862 Building Value: $111,607 $112,345 Market Value: $268,095 $308,207 Assessed Value $147,370 $145,193 Exemption Information: Taxable Value Information: Year: 2011 2010 Homestead: $25,000 $25,000 2nd Homestead: ®® Exemption/ Taxable ••i $500 $500 Senior: $50,000 $50,000 Taxable Value Information: Year: 2011 2010 Applied Applied Taxing Authority: Exemption/ Taxable Exemption/ Taxable Value: Value: Regional: $50,500/ $96,870 $50,500/ $94,693 County: $100,500/ $46,870 $100,500/ $44,693 City: $50,500/ $96,870 $50,500/ $94,693 School Board: $25,500/ $121,870 $25,500/ $119,693 Sale Information: Sale Date: 11/1971 Page 1 of 2 ACTIVE TOOL: SELECT Aerial Photography - 2009 112 ft My Home 1 Property Information 1 PropertyTaxes 1 My Neighborhood I Property Appraiser Home I Using Our Site 1 Phone Directory 1 Privacy 1 Disclaimer If you experience technical difficulties with the Property Information application, or wish to send us your comments, questions or suggestions please email us at Webmaster. Web Site © 2002 Miami -Dade County. All rights reserved. Legend Property Boundary Selected Property Street 1h1 Highway Miami -Dade County Water http: / /gisims2. miamidade .gov /myhome /propmap.asp 6/25/2012 Miami; -Dade My Home Sale Amount: $27,500 Sale O /R: 00000 -0000 Sales Qualification Sales which are qualified Description: View Additional Sales Additional Information: Click here to see more information for this property: Community Development District Community Redevelopment Area Empowerment Zone Enterprise Zone Zoning Land Use Urban Development Boundary Zoning Non -Ad Valorem Assessments Environmental Considerations http://gisims2.miamidade.gov/myhome/propmap.asp Page 2 of 2 6/25/2012 Address Change Lette IBANIETA LLC 758 NE 95 ST MIAMI FL 33138 -2515 03/28/2012 Page 1 of 1 MIAMI-DADE COUNTY OFFICE OF THE PROPERTY APPRAISER REAL ESTATE DIVISION HONORABLE PEDRO J. GARCIA PROPERTY APPRAISER RE: Folio(s) 11320 0141890 Recorded Book and Page 27985 - 4283 The Office of the Property Appraiser is responsible for maintaining ownership records of properties in Miami -Dade County. This function requires verification, research and examination of recorded Deeds and documents received through the Clerk of the Courts Recorder's Office before processing. You are receiving this letter because we need the following information associated with the property referenced above: There appears to be a discrepancy in ownership between our records and the attached recorded Deed /document. In order to transfer ownership and update our records, we will need copies of recorded Deeds, Court Orders and/or Death Certificates supporting the chain of Title, and any other recorded document proving clear Title. At your earliest convenience, please submit all requested documentation to my attention either by mail to our Office address shown below, or fax to 305 -375 -4533. Should you need further assistance, please call 305 - 375 -2641 or 305-375-4064. Thank you. Sincerely, Julie Almeida Real Estate Verification, Deed Supervisor Miami -Dade County Office of the Property Appraisal Attachment(s) 111 NW 1 °1 Street, suite 710 • Miami, Florida • 33128 Phone: (305) 375 -4712 • Fax: (305) 679 -7940 WEB Site www rn amidade.4ovtpa http://panet/PublieServiee/DeedLetter/Deed_changeJetter.asp // anet/ PublicService/ DeedLetter /Deed_change_letter.asp 03/28/2012 Return to: RAPID TULE SERVICES CO. 1175 F (251.11ST, S-512 Nor& Wont FL 33161 Instrument Prepared By CHRISTOPHER P. KELLEY, Esquire 11098 Biscayne Boulevard, Suite 205 Miami, Florida 33161 Folio No. 11-3208-014-1890 WARRANTY DEED tr, THIS INDENTURE, Made this day of December, 2011, Between DAYLE KEPNER, a singlewoman, and ANNE GERSTEL, a married woman, as GRANTORS, and IBANIfTA LIC,,a Florida limited liability company, whose post office address is uts. --`14ce4 tr.,/ .5'nk3,0-S\ , as GRANTEE, WITNESSETH, That said GRANTORS for and in consideration of the sum of Ten and 00/100 Dollars,. and other good and valuable considerations to said GRANTORSIn hand paid by said GRANTEE, the receipt whereof is hereby acknowledged, have granted, bargained and sold to the said GRANTEE, and GRANTEE's successors and assigns forever, the following described land situate, lying and being in Miami-Dade County, Florida to-wit 1111111 1101111111111111111 11111111111111011 CFN 2012R0079671 OR Bk 2798S Pss 4253 - 4294; (2sss; RECORDED 02/03(2012 13135:13 DEED DOC TAX 1020.00 HARVEY RUVIW, CLERK OF COURT MAKI-DADE COUNTY7 FLORIDA Lots 5 and 6, Block 67, MIAMI SHORES SECTION NO. 3, according to the Plat thereof, as recorded in Plat Book 10, Page 37, of the Public Records of Miami-Dade County, Florida. SUBJECT TO: Applicable zoning and/or restrictions and prohibitions imposed by governmental authority; Conditions, Restrictions limitations, reservations, easements, and other matters appearing on records, if any; Utility easements of record, taxes for the year 2011 and subsequent years, and said GRANTORS do hereby fully warrant the title to said land, and will defend the same against the lawful claims of all persons whomsoever. THE ABOVE PROPERTY DOES NOT CONSTITUTE THE HOMESTEAD OF GRANTORS, NOR THEIR IMMEDIATE FAMILIES, NOR IS IT CONTIGUOUS THERETO. THE ADDRESSES OF THE SAID GRANTORS ARE SET OUT BELOW, UNDER THEIR SIGNATURES. IN WITNESS WHEREOF, GRANTORS have hereunto set GRANTORS' hands and seals the day and year first above written, joef.r Signed, sealed, . rid de •ur *resence DAYL PNER 2109 NE 122 Street North Miami, FL 33181 esnattrz_i 57/\61L-7— Pri t Print ANNE GERSTEL 712 Sea Duck Drive Daytona Beach, FL 32119 11(0-M -lbanq--11 Book27985/Page4283 CFN#20120079671 Page 1 of 2 OR BK 27785 PG 4284 LAST PAGE Warranty Deed - Kepner & Gerstel at lbanieta LLC Page 2 STATE OF FLORIDA COUNTY OF MIAMI-DADE ) I HEREBY CERTIFY that on this day, before me, an officer duly authorized in the State aforesaid and in the County aforesaid to take acknowledgments, personally appeared DAYLE KEPNER, who produced n as identification, and who executed the foregoing instrument and acknowledged before me that she executed the same. „...„1 WITNESS my hand and official seal in the16ounty and State last aforesaid this day of December, 2011. stacr sweat 80,4EXPlin411114t251 s#113 OTARY)UBLIC, State of FLORIDA at Large MIXISSION 0 00 $555415 My Commission Expires: ,e7N. STACY SHAFFER • i 41(C,)144100N PO ERRS EfT1tES May 29,2013 Ekauw 11, &a.) SOC.07 STATE OF FLORIDA COUNTY OF /4-At ) I HEREBY CERTIFY that on this day, before me, an officer duly authorized in the State aforesaid and in the County aforesaid tp knowledg,me , onally appeared ANNE GERSTEL, who produced i fiC14/-1-4,4 1 ification, and who executed the foregoing instrument and c nowledged before me that she executed the same. 1TNESS my hand and official seal in the County and State last aforesaid this day of December, 2011. My Commission Expires: '774-4n4 No+, ry RY P , LATOYA A. CAREY Noliry NO114 - sizte of flutd, Af My Comm, Expires PAU 2a, 2014 Commllsion 0 PO 975445 -we ■■■ v.- --ar ORIDA at Large Book27985/Page4284 CFN#20120079671 Page 2 of 2 www.sunbiz.org'- Depaitiitent of State Page 1 of 2 D A IIEPART NT 0 OF OII. .ATI ( ) 'S Home Contact Us E- Filing Services Document Searches Forms Help Previous on List Next on List Return To List No Events No Name History Detail by Entity Name Florida Limited Liability Company IBANIETA, LLC Filing Information Document Number L11000083368 FEI /EIN Number 800783650 Date Filed 07/20/2011 State FL Status ACTIVE Effective Date 07/19/2011 Principal Address 700 NE 90TH ST MIAMI FL 33138 Mailing Address 700 NE 90TH ST MIAMI FL 33138 Changed 04/11/2012 Registered Agent Name & Address ALDABE, JOSIANE 700 NE9OTH ST MIAMI FL 33138 US Manager /Member Detail Name & Address Title MGRM ALDABE, JOSIANE 700 NE9OTH ST MIAMI FL 33138 US Title MGRM ALDABE, FRANCIS 700 NE9OTH ST MIAMI FL 33138 US Annual Reports Report Year Filed Date 2012 04/11/2012 Document Images Entity Name Search tbmi http://www.sunbiz.org/scripts/cordet.exe?action—DETFIL&ing_doc number=L110000833... 6/25/2012 nn ri 4f D e (a0 3( 0 RESIDENTIAL SERVICES CONTRACT 11 5104UE14 ■, DATE E / " AC OUNT INO .�J V JOB NO LEAD NO SOURCE - • •I • - • ADT Security Services, Inc. ( "ADT Office Address IN SITI'll 41q 4- pktilro-g_J-1,„ 1 U (i, , (� 6.1-7,-e, C /' -_c I) , C1 ( w viv!MyADT.coifi 1.800.ADT.ASAP® (1.800.238.2727) ")' Customer ' ( Name "Customer`or "I" or "me" or "my ") �}(� (��/I 1 ' 'C v R , Premises' , Address City Tax Protected , Telephone se lb �/ �� 9 (P I. N //� �7{ 0,04 l i t State 111 ZIP �� . Exempt No:; -�? °+. ' ^+).� t:.:^a Tax Expire Date Premises' O Traditional Phone O Other (Qualified) 0 Other (Non - Qualified) Alternate yy Telephone 1 +�i ,.! t�'a O Home 450 Cell 0 Work Alternate 0 Home 0 Cell 0 Work Telephone 2 O Fill in if billing address is the same Billing Address State ZIP City IF FAMILIARIZATION PERIOD IS R r1ECTED INITIAL HERE (see Paragraph 14 of the Terms and Conditions for explanation) EMAIL..... \^'g/ '"l l /t�f IC.- 41 "��j Communications Authorization: I products and services to the contact 888.DNC4ADT (888.362.4238). Initial Confirmation of Appointments: I authorize appointments and provide other information Alarm System Ownership: 0 Customer I ACKNOWLEDGE AND AGREE TO HAVE READ, UNDERSTAND AUD AGREE THE TERMS AND CONDITIONS. (B) ADDRESS ALL OF MY POTENTIAL PROVIDE ME. ADDITIONAL EQUIPMENT ADT AT AN ADDITIONAL COST TO ALARM SYSTEM CAN PROVIDE COMPLETE MEDICAL PROBLEMS AND OTHER HUMAN ERROR 15 ALWAYS POSSIBLE, OF ADT. ADT MAY NOT RECEIVE ALARM MANUALLY TEST THE ALARM SYSTEM WWW.MYADT.COM. (F) THIS CONTRACT OR SERVICES, AND IF APPROVAL SUCH TERMINATION AND REFUND ADT Represent t Name authorze information here EACH THE SECURITY ME. I INCIDENTS 15 DENIED, ANY ADT to provide with information provided by me. I may unsubscribe and updates about the security system and new ADT and third -party or opt out by emailing donotcontact @ADT.com or by calling calling device to deliver a pre- recorded message to set/confirm at the telephone number(s) provided by me. Initial here ADT to call me using an automated and notices about the alarm -Owned e3 ADT -Owned OF THE FOLLOWING: (A) THIS CONTRACT TO EACH AND EVERY TERM OF THIS INITIAL TERM OF THIS CONTRACT NEEDS. ADT HAS EXPLAINED AND SERVICES OVER THOSE IDENTIFIED HAVE SELECTED AND PURCHASED PROTECTION OR GUARANTEE ARE UNPREDICTABLE AND AND THE RESPONSE TIME OF POLICE, SIGNALS IF COMMUNICATIONS OR MONTHLY AND ANY TIME 1 CHANGE REQUIRES FINAL APPROVAL BY AN THEN THIS CONTRACT WILL AMOUNTS I PAID IN ADVANCE. system ..._..._......._..... . CONSISTS OF SIX (6) PAGES. BEFORE SIGNING THIS CONTRACT, CONTRACT, INCLUDING BUT NOT LIMITED TO PARAGRAPHS 5 AND 18 15 THREE (3) YEARS. (C) ADT IS NOT A SECURITY CONSULTANT AND CANNOT TO ME THE FULL RANGE OF EQUIPMENT AND SERVICES THAT ADT CAN IN THIS CONTRACT ARE AVAILABLE AND MAY BE PURCHASED FROM ONLY THE EQUIPMENT AND SERVICES IDENTIFIED IN THIS CONTRACT. (0) PREVENTION OF LOSS OR INJURY. FIRES, FLOODS, BURGLARIES, ROBBERIES, CANNOT ALWAYS BE DETECTED OR PREVENTED BY AN ALARM SYSTEM. FIRE AND MEDICAL EMERGENCY PERSONNEL 15 OUTSIDE THE CONTROL POWER IS INTERRUPTED FOR ANY REASON. (E) ADT RECOMMENDS THAT TELEPHONE SERVICE, BY CALLING 1.800.ADT.ASAP OR BY LOGGING IN ADT AUTHORIZED MANAGER BEFORE ADT MAY PROVIDE ANY EQUIPMENT BE TERMINATED, AND ADT'S ONLY OBLIGATION WILL BE TO NOTIFY ME Rep. License ed) Rep. (If Requi red) ID No. I OF NO I TO OF - Required (Must match Customer Name in Section 1 above) Customer's Approval' • " X Ni/Z6/1-4S �^--- NOTICE OF CANCELLATION I, THE CUSTOMER, MAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO MIDNIGHT OF THE THIRD BUSINESS DAY AFTER THE DATE OF THIS TRANSACTION. SEE THE ATTACHED NOTICE OF CANCELLATION FORM FOR AN EXPLANATION OF THIS RIGHT. I ACKNOWLEDGE BEING VERBALLY INFORMED OF MY RIGHT TO CANCEL AT THE TIME OF EXECUTION OF THIS CONTRACT AND RECEIPT OF THIS NOTICE. - • Ii T•7i7 • • • FINANCIAL DISCLOSURE STATEMENT THERE IS NO FINANCE CHARGE OR COST OF CREDIT (0% APR) ASSOCIATED WITH THIS CONTRACT. �p /gyp A. NUMBER OF� �� TOTAL OF PAYMENTS FOR THE INITIAL TERM IS� ` S + y PAYMENTS FOR THE B. AMOUNT OF EACH PAYMENT IS (A. TIMES B.) (EXCLUSIVE OF ANY APPLICABLE TAXES FEES, FINES INITIAL TERM IS 36. (TOTAL MONTHLY SERVICE CHARGE FROM BELOW) 1 AND RATE INCREASES) LATE CHARGE - PAYMENT I5 DUE PURSUANT TO MY SELECTED BILLING FREQUENCY, PRIOR TO THE START OF SERVICE. MY FIRST BILUCHARGE WILL BE SENT /MADE SHORTLY AFTER MY SERVICE BEGINS. ADT MAY IMPOSE A ONE -TIME LATE CHARGE ON EACH PAYMENT THAT IS MORE THAN TEN (10) DAYS PAST DUE, UP TO THE MAXIMUM AMOUNT PERMITTED BY LAW, BUT IN NO EVENT WILL THIS AMOUNT EXCEED $5.00. PREPAYMENT — IF I PREPAY THE TOTAL OF PAYMENTS PRIOR TO THE END OF THE INITIAL TERM OF THIS CONTRACT, THERE 15 NO PENALTY OR REFUND. SEE SECTIONS 2, 7, 15 AND 19 OF THIS CONTRACT FOR ADDITIONAL INFORMATION ABOUT NONPAYMENT, DEFAULT AND ACCELERATION. 1 of 6 Administrative Copy - 02011 ADT. All rights reserved. (06/11) RESIDENTIAL SERVICES CONTRACT CONTRACT DATE CUSTOMS ACCOUNT N iiiiii111 5104UE14 11 JOB NO LEAD SOURCE Section 2. Services to be Provided (continued) - ft Standard Monthly Service, Burglary Service includes: Customer Monitoring Center Receiving and Notification Service for Burglary, Manual Fire and Manual Police Emergency b Standard Monthly Service, Fire /Smoke Service includes: Customer Monitoring Center Receiving and Notification Service for Fire, and Manual Police Emergency O Carbon Monoxide 0 Flood 0 Low 0 Medical Alert it Safewatch Cell uard g O SecurityLink O Extended Limited Warranty /Quality Service 0 Guard Response Service 0 Monthly Recurring Municipal Fee (Subject to change based on local 0 Custo o ggqqqbbbbbtain and p f or munic al larjn use per Other ® a Signal Detection Signal Manual Fire Temp Plan (QSP) law) ec 1 Monthly $ 1 $ $ I $ $ $ C $ Q �P $ to the .- e� ono& s'''' -' C��aOe� Service Charge 1\,\ C„ /// I r\ .\ \ \\ V V j first invoice. O Initial /Annual Recurring Municipal Fee billed separately (Subject to change based on local law) 0 Customer t4obtain and pay for initial /annual municipal alarm use permit. Failure to obtain and provide ADT with the municipal alarm use permit registration number could result in no municipal fire /police response to an alarm from the premises and /or a fine. Municipal Electrical Permit Fee 0 Customer to obtain electrical permit -. Installation Price $ Z ^ Taxable Amount Non - Taxable Amount Connection Fee Admin Fee Sales Tax on Installation* tt Total Installation Charge* Deposit Received $ Balance Due upon Installation* Initial /Annual Fee 0 s v c_ c b Total *If applicable sales Section 3. Equipment Control Panel Monthly Service Charge tax not shown, it will be added to be Installed `� �� Aso `o , / Se °so o`�`, Sooc, po °� yr °a, �1 °�� , o , aJ a , moo+ e� ,�. oo` Sa �0 �° ce ' z', �o �s - 4`) k�Ay/t e C2�` Qv�r C Q5�os��,,z,> /,te oz C,a Oe% 4 �'� '0 �> - 0\'off /pS5 10' 'P "/ Comments Package Name: Includes: Foyer Living Room Family Room Office Dining Room Kitchen Laundry Room 1 i '.. i ✓ l ( / �! Hallway Master Bedroom Master Bath T ` : / ,p 1 L III___ 1` / Bedroom 2 Bedroom 3 j Bath 2 Basement Garage Price Per Piece f j t Totals ME! i E = Existing Equipment Estimated Installation Start Date J INSTALLER NOTES 2 of 6 02011 ADT. All rights reserved. (06/11)