Fillable Shared Tenancy Affidavit Form March 2013 (Page 2 of 2) in pdf

Shared Tenancy Affidavit Form March 2013 Page 2

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Student Name _____________________

Please Print

8. I will notify the School District of Brevard County within five (5) working days of any changes in my

residence or the residence of my child.

9. I am fully aware of and understand the School Board’s policy concerning student assignment and neither the

execution of this affidavit nor the living arrangements set forth above violate the intent of such reassignment

policy.

10. If, after 15 school days, acceptable proof of residence has not been provided, the student shall be immediately

withdrawn by school and must be registered and enrolled in the appropriate boundary school by the parent.

11. The students of parents/guardians who falsify address information will be withdrawn and required to enroll at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.

12.

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this shared tenancy affidavit to circumvent enrollment at the zoned school will be withdrawn and required to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

Sworn to and subscribed before me this ________day of __________________, _______________________ (year) by

_________________________________who is personally known to me or who produced _________ as identification.

________________________________________________________

NOTARY PUBLIC, Commission No. _________________________

(SEAL)

My Commission Expires: ___________________________________

FOR SCHOOL USE ONLY

1. Proof of residence provided by RESIDENT (see attached):

________________________________________________________________________________________

2. Proof of receipt of mail or residence address provided by parent/legal guardian (see attached):

________________________________________________________________________________________

3. Proof of other form of legal documentation provided by parent/legal guardian (see attached):

________________________________________________________________________________________

___________________________________________________

__________________

Signature of School Official

Date

Revised by Student Services March 2013

Page 2 of 2

Shared Tenancy Affidavit Form March 2013 Page 2

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