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Get MD MCPS 335-74 2014

My Commission Expires Notary Public To be Completed by School Personnel School Name Date Principal/Designee Phone No. Pupil Personnel Worker MCPS FORM 335-74 Rev. 5/14 DISTRIBUTION COPY 1/Parent COPY 2/Student record COPY 3/Pupil Personnel Worker. Office of Shared Accountability MONTGOMERY COUNTY PUBLIC SCHOOLS Rockville Maryland 20850 SHARED HOUSING DISCLOSURE INSTRUCTIONS Section I To be completed by parent/guardian when residing in a shared housing situation. Section II Notarized signatures of parent/guardian and person who owns or rents the residence must be provided. Section I This is to request that the following school-age children who are residing at the same address below be permitted to enroll in the Montgomery County Public Schools. Name of Parent/guardian Name s of Students Date of Birth Grade / Street Address City State Zip Code It is understood that the above named student s will be permitted to attend Montgomery County Public Schools as long as the above stated address is the bona fide legal residence of the student s and parent s /legal guardian s and that proof of residency 3 supporting documents has been provided* If a change in the bona fide legal residency occurs it is the responsibility of the parent s /legal guardian s and homeowner to notify the school s immediately. shall result in withdrawal of the student s and the appropriate tuition charge shall be assessed for each student s found to be falsely enrolled in the Montgomery County Public Schools. As the homeowner s or renter s of the house or apartment at the address listed above I acknowledge that the above-named individual and their school-age children are residing with me/us in good faith and not solely for the purpose of attending public school in Montgomery County and avoiding nonresident tuition* I agree to provide a current copy of property tax bill current rental lease or if the rental lease is over a year old rental lease and current utility bill* The undersigned do hereby attest to the accuracy of these statements Signature Home Owner/Renter Signature Parent s /Legal Guardian - Print Name Telephone I hereby certify that on this day of the above subscribers personally appeared before me and made oath in due form of the law that the foregoing facts are true to the best of their knowledge information and belief under penalty of perjury. Name of Parent/guardian Name s of Students Date of Birth Grade / Street Address City State Zip Code It is understood that the above named student s will be permitted to attend Montgomery County Public Schools as long as the above stated address is the bona fide legal residence of the student s and parent s /legal guardian s and that proof of residency 3 supporting documents has been provided* If a change in the bona fide legal residency occurs it is the responsibility of the parent s /legal guardian s and homeowner to notify the school s immediately. shall result in withdrawal of the student s and the appropriate tuition charge shall be assessed for each student s found to be falsely enrolled in the Montgomery County Public Schools. .

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