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5111 F2b RESIDENCY VERIFICATION This form must be completed in the presence of the staff member enrolling the student whenever a parent cannot verify that s/he owns or rents a residence in the District. Student s Name School Parent s Name Although I do not own or rent a residence in the District this is to certify that I am the custodial parent of my child named above and our current permanent residence is street address where we are living as guests of Name Telephone who own rent this residence. Should I change this my permanent residence I understand that my child may no longer be eligible to attend school in the District. I will notify the school immediately if my residence changes. Parent Signature School District Witness Date I certify that the above information is correct and the above named student s currently reside in my home. Signature of Residence Owner/Renter SWORN TO BEFORE ME and subscribed in my presence this day of Notary Public 2/98. Student s Name School Parent s Name Although I do not own or rent a residence in the District this is to certify that I am the custodial parent of my child named above and our current permanent residence is street address where we are living as guests of Name Telephone who own rent this residence. Should I change this my permanent residence I understand that my child may no longer be eligible to attend school in the District. Should I change this my permanent residence I understand that my child may no longer be eligible to attend school in the District. I will notify the school immediately if my residence changes. Parent Signature School District Witness Date I certify that the above information is correct and the above named student s currently reside in my home. I will notify the school immediately if my residence changes. Parent Signature School District Witness Date I certify that the above information is correct and the above named student s currently reside in my home. Signature of Residence Owner/Renter SWORN TO BEFORE ME and subscribed in my presence this day of Notary Public 2/98. Student s Name School Parent s Name Although I do not own or rent a residence in the District this is to certify that I am the custodial parent of my child named above and our current permanent residence is street address where we are living as guests of Name Telephone who own rent this residence. Should I change this my permanent residence I understand that my child may no longer be eligible to attend school in the District. I will notify the school immediately if my residence changes. Parent Signature School District Witness Date I certify that the above information is correct and the above named student s currently reside in my home. Should I change this my permanent residence I understand that my child may no longer be eligible to attend school in the District. I will notify the school immediately if my residence changes. Parent Signature School District Witness Date I certify that the above information is correct and the above named student s currently reside in my home. Signature of Residence Owner/Renter SWORN TO BEFORE ME and subscribed in my presence this day of Notary Public 2/98.

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Keywords relevant to Form 5111

  • notary
  • verification
  • reside
  • Rents
  • residency
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