Affidavit (Or Affirmation) And Application For Certificate Of Residence For Warren County Residents printable pdf download

PLEASE PRINT ALL INFORMATION

PPLICATION FOR

ERTIFICATE OF

ESIDENCE

Last Name _______________________

First Name ___________________________

Community College_________________________ Semester ___________________________

Important: A Certificate of Residence must be dated two (2) months or less prior to the start of the semester.

AFFIDAVIT (OR AFFIRMATION) AND APPLICATION

FOR CERTIFICATE OF RESIDENCE

For Warren County Residents

Pursuant to Article 126, Sections 6301 & 6305 of the Education Law.

In connection with attendance at community college*

STATE OF NEW YORK

COUNTY OF WARREN

I, ___________________________________________________ do hereby swear (or affirm) that I reside at

(applicant’s full name)

County of Warren, State of New York; that now I

__________________________________________________________________,

(Permanent address including city/town with zip code)

am and have for a period of at least one year immediately prior to the date of this affidavit (or affirmation) and

application been a resident of State of New York, that I now am, and have been for ___ months within th last six

months immediately prior to the date of this affidavit (or affirmation) and application, ** a resident of Warren

County and that I have lived at the following places during the year immediately prior to this affidavit (or

affirmation) and application:

ADDRESS

DATES

I further state that I plan to enroll in classes at __________________________________________ and that this

(Community college)

affidavit (or affirmation)and application is made for the purpose of securing from the Chief Financial Officer of the

County of Warren a certificate of residence pursuant to the requirements of Article 126 of the Education Law.

____________________________________________

(Sign in the presence of Notary Public or Commissioner of Deeds)

Your signature must be notarized before this affidavit (or affirmation) is submitted,

Sworn to (or affirmed) before me this

_______ Day of _________________, 20___

____________________________________

(Notary Public or Commissioner of Deeds)

THIS SPACE FOR USE OF CHIEF FISCAL OFFICER (TREARUER) OF WARREN COUNTY

CERTIFICATE ISSUED ( ) CERTIFICATE NOT ISSUED ( )

DATE ______________

BY _____________________________

Education Law, Section 6305 provides; The Chief Fiscal Officer of each county, as defined in section 2.00 of the local finance law

“shall, upon application and submission to him of satisfactory evidence, issue to any person desiring to enroll in a community college as a

nonresident student, a certificate of residence showing that said person is a resident of said county. Such person shall, upon registration

for each college year, file with the college such certificate of residence issued not earlier than two months prior thereto, and such

.”

certificate of residence shall be valid for one year from the date of issuance

Education Law, Section 6301, paragraph 4 defines: “Resident-A person who has resided in the state for a period of at least one year and

in the county, city, town, intermediate school district or school district, as the case may be, for a period of at least six months, both

immediately preceding the date of such person’s registration in a community college or for the purposes of section 6305 of this chapter,

his/her application for a certificate of residence.”

**In the event that a person qualified as above for state residence but has been a resident of two or more counties in the state during

the six months immediately preceding his/her application for a certificate of residence pursuant to section 6305 of this chapter, the

charges to the counties of residence shall be allocated among the several counties proportional to the number of months, or major

fraction thereof, of residence in each county.

Affidavit (Or Affirmation) And Application For Certificate Of Residence For Warren County Residents

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