Residency Affidavit printable pdf download

Residency Affidavit

5111 F2a

RESIDENCY AFFIDAVIT

STATE OF OHIO ) ss

COUNTY OF ______________)

____________________________________, being by me duly sworn, did personally appear and state

before me, a Notary Public, in and for said County and State, that his/her "legal residence" (address)

(and that of his/her child/children) is

__________________________________________________________________________________

(Street Number and Street)

(City)

(State)

(Zip Code)

It is understood, that for the purpose of this document the term "legal residence" means that residence

where the parent/guardian in question eat their meals and sleep on a regular basis, receive their mail,

and if applicable where the parent(s) are registered to vote.

Signed (Affidavit)_________________________________________

___________________________________________, being by me duly sworn, did personally appear

and state before me, a Notary Public, in and for said County and State, that s/he is the owner/lessee of

the address sworn to above.

Signed (Affidavit)_________________________________________

(Phone #)____________________________

SWORN TO BEFORE ME AND SIGNED THIS______ DAY OF__________________19____

SIGNED________________________________

NOTARY PUBLIC

STATE OF OHIO

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NOTICE: READ CAREFULLY: Knowingly falsifying this document is a violation of the Ohio Revised

Code: Section 2921.13(A) (6) which is a First Degree Misdemeanor punishable by a prison term of six

(6) months and/or a fine up to $1000.00. Further the affiant will be billed (and prosecuted in court, if

necessary) to collect all back tuition which may be due.

Inaccurate and/or false information will result in immediate withdrawal of your child(ren) from the

____________________________________________. (School District)

Residency Affidavit