Carbon Monoxide Detector Notice (C.A.R. Form CMD, 4/12) Completed Form Examples and Samples

View a detailed example of a filled-out Carbon Monoxide Detector Notice (C.A.R. Form CMD, 4/12). This sample helps landlords and tenants understand how to properly complete the form, including property details, detector status, and signatures, in compliance with California law.
Carbon Monoxide Detector Notice (C.A.R. Form CMD, 4/12) has a basic Form Complexity Index of 38/100 — Instafill’s AI completes it in under a minute.
Fill out form with AI
Download PDF Example
Field Instructions
Completed sample of a Carbon Monoxide Detector Notice (C.A.R. Form CMD, 4/12) for a California residential lease.

Carbon Monoxide Detector Notice (C.A.R. Form CMD) Example

How this form was filled:

This is an example of a filled-out Carbon Monoxide Detector Notice (C.A.R. Form CMD). It shows how a landlord provides the required notice to a tenant about the presence, location, and maintenance of CO detectors in a rental property, complete with signatures from both parties.

Information used to fill out the document:

  • Prepared by (Landlord): Olivia Chen
  • Property Address: 456 Oak Avenue, Sunnyvale, CA 94086
  • Date Prepared: February 10, 2026
  • Referenced Agreement: Residential Lease Agreement
  • Agreement Date: February 1, 2026
  • Landlord Name: Olivia Chen
  • Tenant Name(s): Marcus Johnson
  • Detector Status: Property is equipped with the required number of carbon monoxide detectors in compliance with applicable law.
  • Tenant's Responsibility: Tenant agrees to test the detector(s) periodically and replace batteries as necessary.
  • Landlord Signature: Olivia Chen
  • Tenant Signature: Marcus Johnson
  • Signature Date: February 10, 2026

What this filled form sample shows:

  • Clearly identifies the specific **property address**, landlord, and tenant.
  • References the primary **Residential Lease Agreement** and its date.
  • Confirms the property is equipped with **CO detectors** as required by law.
  • Outlines the **tenant's responsibilities** for maintaining the detectors.
  • Includes dated **signatures from both the landlord and tenant** to create a legal record of acknowledgment.

Form specifications and details:

Form Name: Carbon Monoxide Detector Notice
Form ID: C.A.R. Form CMD, 4/12
Issuing Body: California Association of REALTORS®
Use Case: Notification for a residential lease agreement.
Jurisdiction: California, USA
Categories: CAR forms
Created: February 05, 2026 08:01 PM
Completed sample of a Carbon Monoxide Detector Notice (C.A.R. Form CMD, 4/12) for a California residential lease.