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Resident Emergency Information

This form is intended only for emergency contact information for residents who do not have a landline connected to the home, and only utilize a cell phone or an internet based phone service not connected to our 911 system. If you have a regular landline in your home, you are already on our emergency list through the 911 system and do not need to complete this form.

 
First Name: *
Last Name: *
Cell/Internet Phone: *
Address:
City, State Zip: ,
Access code: Type the characters you see in the picture below.
 
 
* Required Field
The Town of San Anselmo - 525 San Anselmo Avenue, San Anselmo CA 95949 - 415.258.4600
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