Residency Affidavit Form - Avon School District
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1Residency Affidavit Form
1.
I, ____________________________________ (landlord name, please print)
own a home or apartment which I rent to the party named below.
attest that the person named below lives with me a the following address.
2.
I certify that the following person(s) are residing full time at the address listed below
Name(s) of Guardian(s)
Child(ren) Name(s)
Street Address – City – Zip Code
3.
As Owner/Lessor, I agree to provide the school ONE of the following items in my name for the property
address listed above for proof of residency:
A current* tax bill
A current* utility (gas, water, or electric)
•
•
bill
A current* mortgage statement
•
* Current is defined as within the past 30 days
A current* lease or rental agreement
•
A current* governmental agency mail
•
(county, state, or federal)
As Owner/Lessor, I understand that this statement is being made in order to provide proof of
Owner
residency so that the above named child(ren) may be admitted to Avon School District. I agree to
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notify Avon School if the rental agreement becomes null and void.
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As the enrolling parent(s)/guardian, I, ______________________________, attest that I do not live
in any other residence. I also attest that the living arrangement is not solely for the purpose of
Guardian
establishing school attendance eligibility. I understand that if I establish my own residence, I will
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immediately provide the school with proof address in my name. This Residency Affidavit will expire
as of June 28, 2010.
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Each person executing this affidavit authorizes Avon School District to verify the information
provided herein, including the address from a social service agency, gas, water, or electric utility.
Guardian
Each of the undersigned authorizes such agency or utility to provide any requested information to
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verify any representation made herein.
Notary Signature - Public Seal
Signature of Enrolling Guardian
Date
Notary Signature - Public Seal
Signature of Landlord
Date
For Office Use Only:
Original to
Copy to
Approved:
School
Guardian
School Administrator or Designee
Date
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