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Get Washoe County Heatlth Notice Of Exemption

WASHOE COUNTY HEALTH DISTRICT AIR QUALITY MANAGEMENT DIVISION NOTICE OF EXEMPTION FOR VALIDATION RETURN - Original AND One Copy plus a check for 14. 00 mailed to The undersigned affirm there is no wood stove pellet stove or fireplace insert on the property at Property Address City APN State Title Company or Mobile Home Dealer Zip Escrow Number Closing Date RESIDENCE CONTAINS mark all that apply MANUFACTURED GAS UNIT or GAS RETROFIT FIREPLACE ONLY Doors are not gasketed to make device airtight. WASHOE COUNTY HEALTH DISTRICT AIR QUALITY MANAGEMENT DIVISION NOTICE OF EXEMPTION FOR VALIDATION RETURN - Original AND One Copy plus a check for 14. 00 mailed to The undersigned affirm there is no wood stove pellet stove or fireplace insert on the property at Property Address City APN State Title Company or Mobile Home Dealer Zip Escrow Number Closing Date RESIDENCE CONTAINS mark all that apply MANUFACTURED GAS UNIT or GAS RETROFIT FIREPLACE ONLY Doors are not gasketed to make device airtight. NO SOLID FUEL BURNING DEVICE UNCERTIFIED WOODSTOVE REMOVED FROM PROPERTY PRIOR TO SALE* Not Previously Inspected SELLER BUYER Print Name Seller Signature Date Buyer Signature NOTARY County of This instrument was acknowledged before me by on of. NOTARY SEAL This form is located on our web site at www. ourcleanair. com The above signed hereby swear or affirm under penalties prescribed for perjury in NRS 199. 120 that the provided information is true and correct of their knowledge. Perjury is a felony subject to up to 10 years in prison and a 10 000 fine. New owner agrees to allow District Health Department access to property to perform verification inspection for a period not to exceed 30 days from date of close of escrow. 00 mailed to The undersigned affirm there is no wood stove pellet stove or fireplace insert on the property at Property Address City APN State Title Company or Mobile Home Dealer Zip Escrow Number Closing Date RESIDENCE CONTAINS mark all that apply MANUFACTURED GAS UNIT or GAS RETROFIT FIREPLACE ONLY Doors are not gasketed to make device airtight. NO SOLID FUEL BURNING DEVICE UNCERTIFIED WOODSTOVE REMOVED FROM PROPERTY PRIOR TO SALE* Not Previously Inspected SELLER BUYER Print Name Seller Signature Date Buyer Signature NOTARY County of This instrument was acknowledged before me by on of. NO SOLID FUEL BURNING DEVICE UNCERTIFIED WOODSTOVE REMOVED FROM PROPERTY PRIOR TO SALE* Not Previously Inspected SELLER BUYER Print Name Seller Signature Date Buyer Signature NOTARY County of This instrument was acknowledged before me by on of. NOTARY SEAL This form is located on our web site at www. ourcleanair. com The above signed hereby swear or affirm under penalties prescribed for perjury in NRS 199. NOTARY SEAL This form is located on our web site at www. ourcleanair. com The above signed hereby swear or affirm under penalties prescribed for perjury in NRS 199. 120 that the provided information is true and correct of their knowledge. Perjury is a felony subject to up to 10 years in prison and a 10 000 fine.

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