Usta/midwest Section Declaration Of Domicile printable pdf download

USTA/MIDWEST SECTION

DECLARATION OF DOMICILE

Player’s Name:______________________________________________ Birthdate:_____________________

Gender: __M __ F

Qualifier Age Division Entered: __12 & U __14 & U __16 & U __ 18 & U

USTA/Midwest Section District _______________________________________________________________

LEGAL ADDRESS: (A Post Office Box will not be allowed as a resident address)

________________________________________________________________________________________

Street Number

________________________________________________________________________________________

City

State

Zip

Home Phone: (_______) ____________________________

Parent/Guardian Email Address:_______________________________________________________

I, _______________________________, parent/legal guardian of the above named player, hereby certify that said player

resides with me at the above address within the boundaries of the USTA/Midwest Section and the District holding the

closed event.

_____________________________________________________________ Date: ___________________________

Signature of Parent/Legal Guardian

ADDITIONAL INFORMATION REQUIRED WITH THIS STATEMENT OF PLAYER

DOMICILE:

1. A photocopy of the “parents’” most recent state income tax return or a printed copy of the

electronic file form.

2. A photocopy of the “parents” most recent federal income tax return or a printed copy of the

electronic file form.

3. A copy of a Declaration of Domicile, signed by the “parents” proving that the player’s

“parents” live in the USTA/Midwest Section. The document must be notarized.

4. Affidavit of domicile executed by the head of the household.

5. Photocopies of “parents” and players (when applicable) driver’s licenses and automobile

registration (s).

6. Notarized copy of “parents” voter registration.

7. Photocopy of Homestead Tax Credit (all states except Ohio, unless the “parents” meet the

special requirements in Ohio)

SEND THIS COMPLETED FORM WITH SUPPORTING DOCUMENTATION TO:

The appropriate District Association Office for a determination of eligibility based on Domicile.

Call the District Office for confirmation of receipt.

District Association contact information can be found at

Usta/midwest Section Declaration Of Domicile