Form Rev-1329 Ex - Corrected School District Code Report

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REV-1329 EX (01-11)

Original Response

Page

REMOVE INDIVIDUAL(S) FROM LISTING OF:

Response from Second School District

START

Contact Name and Phone Number

DISTRICT NAME

DISTRICT CODE

Response from Third School District

Contact Name and Phone Number

CORRECTED SCHOOL DISTRICT

COUNTY

CODE REPORT

SECOND SCHOOL DISTRICT

THIRD SCHOOL DISTRICT

INDEX

Assign Individual(s) to:

NAME

NUMBER

NO.

ADDRESS

SCHOOL DISTRICT NAME

CODE

SCHOOL DISTRICT NAME

CODE

(#)

See reverse for instructions regarding affidavit of notice to second or third school district.

REASON – SEE INSTRUCTIONS

INDIVIDUAL COMPILING THIS ORIGINAL LIST:

MM/DD/YY

NAME ________________________________________________ TITLE ________________________________ TELEPHONE NUMBER ____________________________ DATE _______________

ASSIGNMENTS MADE MORE THAN 20 DAYS AFTER YOU RECEIVE THE ACT 80 LIST WILL NOT BE ACCEPTED.

RESET ENTIRE FORM

PRINT FORM

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