Vadim Burshteyn Affidavit of __________________________________ Property Owner

******************************* The Affiant after being duly sworn, states as follows:

Vadim Burshteyn My name is ____________________________________________________. I am the owner of the

9614 Westport Road # 12 property located at ________________________________________ in Jefferson County, Kentucky.

9614 Westport Road # 12 I hereby attest that the property located at ____________________________________ in
Jefferson County, Kentucky has been transferred to a new party. I further hereby attest that in accordance with Section IV(F) of Ordinance 69, Series 2003, I have installed approved type smoke detector(s) in accordance with Section III(A) of Ordinance 69, Series 2003 prior to the transfer of said property.

I hereby attest that I understand that in order to comply with Section III(A) of Ordinance 69, Series 2003 only ionization or photoelectric type detectors approved by a nationally recognized testing laboratory shall be installed. Approved type smoke detectors are defined as smoke detectors with a hard wire AC primary power source operated from an outlet not controlled by any switch other than the main power supply and fitted with a plug restraining device or by self-monitored, non-removal 10 year lithium batteries.

Vadim Burshteyn ___________________________________________ Property Owner

___________________________________________ Date STATE OF KENTUCKY COUNTY OF JEFFERSON Subscribed and sworn to before me by _______________________________________ this ____________ day of _____________________________, 20_____. My Commission expires: ___________________________________________ _________________________________________ Notary Public

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