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2. The DeSoto County Emergency Management Agency, in conjunction with the Board of Supervisors and the State Fire Marshals Office, is excited to offer free smoke alarms and smoke alarm installation to residents in the unincorporated county. Once the application is received, a representative from the DeSoto County Government will reach out to you to schedule a time for installation. The number of alarms is limited, so alarms will be provided on a first come, first served basis.
4. Contact Information:
6. First Name of Applicant:*
7. Last Name of Applicant:*
9. Primary Phone Number:*
10. Secondary Phone Number:
12. Email Address:
16. Property Information for location where alarms will be installed
    This information will allow DeSoto County EMA to better assess the number of smoke alarms that will be needed in the home:
18. Address of location to install alarms
20. Street Address*
21. City:*
22. Zip Code: *
24. Number of people living in the home:*
    -- Select One --12345678910+
25. Number of older adults living in the home:*
    -- Select One --012345678910+
27. Number of children under age 14 living in the home:*
    -- Select One --012345678910+
28. Total number of people with a disability living in the home:*
    -- Select One --012345678910+
30. Total number of people who are deaf living in the home:*
    -- Select One --012345678910+
31. Total number of people who are hard of hearing living in the home:*
    -- Select One --012345678910+
33. Number of levels in the home:*
    -- Select One --12345678910+
34. Number of Bedrooms: *
    -- Select One --012345678910+
36. Number of smoke alarms currently installed in home: *
    -- Select One --012345678910+
Leave This Blank:


38. 1. Receive an email copy of this form.
39. Email address

    This field is not part of the form submission.

40. Submit

* indicates a required field