Westfall Local School District
19463 Pherson Pike
Williamsport, OH 43164
Residence Verification Form – Affidavit I
I, ______, certify that I am a resident of the Westfall Local School District at:
Address: ______
City/Zip Code: ______
Date of Occupancy: ______
Verification of above residence provided to school officials by copy of one of the following items:
____ Official Rental/Lease Agreement ___ Mortgage coupon
____ Rent receipt with landlord verification ___ Property tax statement
___ Two current utility bills
____ Special circumstances
1. Applicant resides with another person. The person with whom you are living with must provide an official rental/lease agreement, rent receipt with landlord verification, mortgage coupon, property tax statement or two current utility bills along with the notarized resident verification form (Affidavit II).
2. Parents are building a house in the district. A sworn statement indicating the location of the house and the parent’s intent to reside there, together with a statement from the builder confirming that a house is being built for that person at the indicated location are required. Exception is limited to a period of time not to exceed 90 days.
3. Parents are purchasing a house in the district. A sworn statement indicating the location of the house and the parent’s intent to reside there, together with a statement from a real estate broker or bank officer confirming that a purchase contract has been entered into and that the parent is awaiting the closing of a mortgage loan are required. Exception is limited to a period of time not to exceed 90 days.
I, ______, further certify that the above information is true and accurate. Should any of this information be false I agree to pay tuition cost per day for each student listed below while illegally attending Westfall Local Schools. I understand that if payment is not made immediate withdrawal will occur. I am aware that the Westfall Local School District may use legal means to verify my residence.
Child (ren) Birth date Grade
· ______
· ______
· ______
______
Signature of Person Enrolling Child Relationship to child Date
Office Use:
Affidavit I – When completing this form examples or proof that must be presented:
(Official Rental/Lease Agreement OR Rent Receipt with landlord verification OR Mortgage coupon OR Property tax statement OR Two current utility bills) 8/2009
Westfall Local School District
19463 Pherson Pike
Williamsport, OH 43164
Resident Verification Form – Affidavit II
I, ______, being duly cautioned, do solemnly swear or affirm the following:
1. I am the owner or renter of the residence at ______
______, Ohio located in the Westfall Local School District.
2. The following individual (s) ______
______
Is/are living at my above stated residence and have so since the _____day of ______, 20 _____.
3. I acknowledge and understand that if the above information is not true and correct, that knowingly swearing or affirming the truth thereof constitutes criminal falsification, a violation of Ohio Revised Code Section 2921.13, a first degree misdemeanor, punishable by a maximum fine of $1,000.00 and/or a maximum term of imprisonment of six months. Further, if the student is found to not be a legal resident, the district will seek remuneration for each day the student illegally attended school in the district.
I agree that the Westfall Local Schools, if they deem necessary, have the right to investigate my residency. I agree to allow the release of rental information and also utility customer information to a representative of the Westfall Local Schools.
Signature: ______
(Property owner/Lessee)
Sworn to and ascribed in my presence this ______day of ______, 20 ______
______
Notary Public
Stamp
Or
Seal
Office Use:
Affidavit II – Must be completed and notarized if residing with someone. 8/2009