Fillable Shared Tenancy Affidavit Form March 2013 printable pdf download

Student Name _____________________

Please Print

BREVARD PUBLIC SCHOOLS

SHARED TENANCY AFFIDAVIT

INSTRUCTIONS

Any parent registering in Brevard Public Schools who cannot produce a property deed or lease may ask owner or

lessee of the property where the applicant lives to complete and sign this legal affidavit.

RESIDENT

BEFORE ME, the undersigned authority, personally appeared _________________________________ who after first

being duly sworn, deposed and says:

actual leaser/owner of residence

1. My name is ________________________________________ and I am a resident of Brevard County, Florida.

2. _________________________________________________________________ currently resides with me at:

parent/guardian

(NO PO BOX ALLOWED)__________________________________________________________________

Children of the above parent/guardian that will be residing in my home:

Child’s full name_______________________________________________ Birth Date___________________

Grade _______ Name of last school attended ____________________________________________________

Child’s full name_______________________________________________ Birth Date___________________

Grade _______ Name of last school attended ____________________________________________________

3. My home/cell telephone number is __________________________

I am aware that anyone who knowingly makes a false statement in writing with the intent to mislead a public

servant in the performance of his/her official duty shall be guilty of a misdemeanor of the second degree,

punishable as provided in 837.06. The students of parents/guardians who falsify address information or use

this shared tenancy affidavit to circumvent enrollment at the zoned school will be withdrawn and required to

enroll at the zoned school. Student may forfeit any future opportunity to attend a school other than his/her

zoned school.

Signature of Resident________________________________________

PARENT / GUARDIAN

BEFORE ME, the undersigned authority, personally appeared _________________________________ who after first

being duly sworn, deposed and says:

5. I have left my former residence and neither I nor my child(ren) occupy the former residence for any purpose

any longer.

6. I am receiving mail at the address listed above (must provide at least one (1) piece of mail to include a credit

card or cell phone statement; mail from financial institutions, including checking, savings, or investment

account statements not more than two months old; mail from Federal, State, County or City government

agencies)

7. I have changed other forms of legal documentation to the above address (driver’s license, voter registration,

etc.)

Revised by Student Services March 2013

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Shared Tenancy Affidavit Form March 2013