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Semester(s): (check all that apply)

Winter

Spring

Summer

Fall of 20_______ (Year)

Affidavit (or affirmation) and application for

CERTIFICATE OF RESIDENCE,

pursuant to Education Law, sections 6301* and 6305**,

in connection with attendance at a community college

Previous certificate of residence on file?

Yes _______ No ______ If yes, what year? ________________________

I, (name) __________________________________________________, do hereby declare that I reside at (ADDRESS):

________________________________________________________________________ County of ORANGE, State of New York;

that I am now, and have for a period of at least one (1) year immediately prior to the date of this affidavit (or affirmation) and

application, been a resident of the New York State; that I am now a resident of the County of ORANGE, for at least six (6)

months.

CITIZENSHIP: Unites States Citizen:

Yes ______ No _____ SS#: ____________________________________

If you are NOT a citizen, please provide the following: (ATTACH COPY OF ALIEN IDENTIFICATION CARD)

Alien Identification Card #:_____________________________ Date of Issue: _______________________________

If not, I declare that I have lived in New York State at the following address during the year immediately prior to the date of this

affidavit (or affirmation) and application:

Previous Address: __________________________________________________________________________________________

Dates: From: ___________________ To: ____________________

County: ________________________

(A partial certificate can be issued if the student has lived in New York State for at least one year.)

Applicant further states that I plan to enroll in _____________________________Community College (College or Institute) and

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

County of ORANGE a Certificate of Residence pursuant to the requirements of Article 126* of the Education Law.

PLEASE SIGN FORM IN THE PRESENCE OF A NOTARY PUBLIC

__________________________________________________

_____________________________________________

Signature of Applicant

Applicant’s telephone number and email address

__________________________________________________

Notary Public’s Signature

Sworn to before me this _____ day of __________, 20_____

* 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 sixty-three hundred five of this chapter, his application for a certificate of residence.

** 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, issued to any person desiring to enroll in a

community college as a non-resident student, a certificate of residence showing that said person is a resident of said county.

Such person shall, upon his registration for each college year, file with the college such a certificate of residence issued not

earlier than two months prior thereto, and such certificate of residence shall be valid for a period of one year from the date of

issuance.”

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 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.

SUNY B-80

Revised 06-10-2016

Form Suny B-80 - Affidavit (Or Affirmation) And Application For Certificate Of Residence - Orange County Department Of Finance

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