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Get Shelby County Schools Shared Residence Affidavit

Nother person SEVEN DAYS A WEEK YEAR ROUND. This affidavit must be re-certified through Student Services annually. All sections must be completed and signatures notarized. DO NOT SIGN THIS FORM IF ANY OF THE STATEMENTS ARE INCORRECT. Evidence of false information will result in immediate withdrawal of the student(s) from school. To be completed by Parent(s)/ Guardian(s): Student: ___________________________________ Last Name First Name Sex: M F Birth Date: _____/_____/_____ Grade: ________ .

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