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Residency Affidavit Form

Required

NYACK UNION SCHOOL DISTRICT
RESIDENCY AFFIDAVIT

The district will investigate the residency of families who use a Residency Affidavit before a registration appointment can be made.

Name(s)

Pursuant of Section 3202 of the Education Law

STATE OF NEW YORK

 

COUNTY OF ROCKLAND

Name of Legal Owner/Tenantrequiredbeing duly sworn, deposes and says:
First Name
Last Name
being duly sworn, deposes and says:

and the person or persons as follows:

Telephone number where the family listed in #2 above can be reached.

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

6. 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 in making determinations based on the accuracy of statements.

A RECENT TELEPHONE BILL OR O&R BILL and A SIGNED LEASE OR CLOSING STATEMENT/DEED OF THE LEGAL OWNER/TENANT MUST BE RETURNED WITH TIS AFFIDAVIT.

Under PENALTIES OF PERJURY, the statements in this application are true. I understand that the statements in this application are subject to verification by the Nyack Union Free School District and that false statements could subject me to transportation and/or tuition charges where applicable. ANY FALSE STATEMENT MADE IN THIS APPLICATION IS ALSO PUNISHABLE AS A CLASS "A" MISDEMEANOR PURSUANT TO SECTION 210.45 OF THE PENAL LAW.

Must contain a date in MM/DD/YYYY format
Attach up to 1 file with a maximum size of 10MB
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Attach up to 1 file with a maximum size of 10MB
No file chosen

Please complete the security verification below.