Landlord Affidavit Form

Required

NYACK UNION FREE SCHOOL DISTRICT
LANDLORD AFFIDAVIT FOR RENTERS

The district will investigate the residency of families who use a Landlord’s Affidavit for Renters.

PROVIDING ANY FALSE INFORMATION, STATEMENTS, OR PROOF OF RESIDENCY IS A VIOLATION OF LAW AND WILL BE SUBJECT TO LEGAL ACTION AND THE PAYMENT OF TUITION.

In the matter of the Investigation of the Residency Status of: required

Home Phone:required

Cell Phone:required

Pursuant to Section 3202 of the Education Law

STATE OF NEW YORK

ss:

COUNTY OF ROCKLAND

Name of Landlord:requiredbeing duly sworn, deposes and says:

First Name

Last Name

being duly sworn, deposes and says:

1. I am the owner or corporate officer of the owner of property within the NYACK UNION FREE SCHOOL DISTRICT, located at: required

2. I have rented or leased occupancy of the address described above, at a monthly rent of required

to:required

and the person or persons as follows:

1.required

To the best of my knowledge and information, the persons named above are residents of the described premises.

3. The foregoing statements are made by me on the knowledge that the information I have given will be used by the NYACK UNION FREE SCHOOL DISTRICT to make determinations based on the accuracy of these statements.

Signature of Landlord) required

Attach up to 1 file with a maximum size of 10MB

No file chosen

Sworn to before me thisrequired

Must contain a date in MM/DD/YYYY format

(Notary Public)required

Attach up to 1 file with a maximum size of 10MB

No file chosen

A RECENT RENT RECEIPT AND A RECENT UTILITY OR TELEPHONE BILL, OR OTHER DOCUMENTATION, MUST BE PRESENTED WITH THIS AFFIDAVIT.

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Landlord Affidavit Form

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