Affidavit of Residence Templateshunter

PARENT AFFIDAVIT OF RESIDENCY 
In accordance with Chancellor’s Regulation A-101, if a parent is subletting an apartment or home, or if more than one family shares a living space and there is only one leaseholder or homeowner, the parent must present a notarized “Address Affidavit” signed both by the primary leaseholder as well as the parent affirming that the family is residing in this home, and must attach the lease or deed.
Section A: STUDENT INFORMATION – Please print clearly in ink

STUDENT’S LAST NAME  STUDENT’S FIRST NAME  GENDER (optional) M / F

DATE OF BIRTH (MM/DD/YY)  OSIS #/STUDENT’S ID # (if available)  TELEPHONE #



STUDENT’S CURRENT ADDRESS (House #, Street, Apt. #, City, State and Zip Code)



Section B: PARENT INFORMATION – Please print clearly in ink

PARENT/GUARDIAN’S LAST NAME   PARENT/GUARDIAN’S FIRST NAME



PARENT/GUARDIAN’S CURRENT ADDRESS (House #, Street, Apt. #, City, State and Zip Code)



HOME PHONE   WORK PHONE   CELL PHONE   EMAIL ADDRESS



Section C: PRIMARY RESIDENT/TENANT INFORMATION – Please print clearly in ink

PRIMARY RESIDENT/TENANT’S LAST NAME  PRIMARY RESIDENT/TENANT’S FIRST NAME



PRIMARY RESIDENT/TENANT’S CURRENT ADDRESS (House #, Street, Apt. #, City, State and Zip Code)



HOME PHONE   WORK PHONE   CELL PHONE   EMAIL ADDRESS



RELATIONSHIP TO PARENT     ANTICIPATED DURATION OF STAY













              Chancellor’s Regulation A-101                       Attachment No. 3                   Page 2 of 2

  To be completed by the Parent:

I, _________________________________________, the parent of ___________________________________________,                (insert name and date of birth of student) hereby affirm that I am residing with _____________________________________________________________________          (insert name) at the following address ______________________________________________________________________________.      (insert address and contact number of primary leaseholder)
I understand that the New York City Department of Education has the right to conduct an Attendance Investigation to verify my residence including a visit to the home of the primary leaseholder.  I also understand that registration in school is based on eligibility determined by my residence, and the Department of Education has the right to transfer students for whom falsified documentation was provided at the time of registration. In the event that my residency changes, I agree to notify my child’s school and present new proof of address.


Parent Signature: _______________________________________________________

STATE OF NEW YORK SS: COUNTY OF 
Sworn to before me this _______ day of _______________________, Year _________
         Notary Public

To be completed by Primary Leaseholder/Tenant:

I hereby affirm that __________________________________________________________________________________        (insert name of parent and child/children) are residing with me at _______________________________________________________________________________.        (insert address)

I understand that by signing this affidavit I am verifying the residence of  ________________________________________.            (insert names)

I also understand that the New York City Department of Education has the right to conduct an Attendance Investigation to verify the residence of the parties named in this affidavit, including a visit to my home and interviews with my neighbors.  I can be contacted at the number(s) listed below should the Department of Education require further information.


Primary Leaseholder Signature: ____________________________________________

STATE OF NEW YORK SS: COUNTY OF 
Sworn to before me this _______ day of _______________________, Year _________