FireSmart Assessment Application

Required fields are marked with an asterisk (*)

FireSmart Assessment Application

General Information:

Applicant's First and Last Name *

Applicant's Email Address: *

Property Address (Assessment Location):

Community

Type of Property:

Phone (home):

Phone (cell):

Postal Code: *

Applicant Contact Information

Are you the property owner or a legal representative?

Property Owner

Legal Representative

Is the property owner(s) aware of this application?

Yes

Property Profile

Are you a year-round or part-time resident?

Year-round

Part-time

Which best describes your residence?

Primary

Secondary/Vacation

Rental Property

In accordance with Section 485 of the Municipal Government Act (MGA), any personal information collected on this form will only be used by municipal staff and, if necessary, individuals and/or organizations under service contract with the Halifax Regional Municipality to provide services related to the FireSmart Assessment Application.

If you have any questions about the collection and use of this personal information, please contact the Access and Privacy Office at 902.943.2148 or privacy@halifax.ca.