residency attestation form - J. Sterling Morton High School District

J. Sterling Morton High School District #201
Serving the Communities of Berwyn, Cicero, Lyons, McCook and Stickney
RESIDENCY ATTESTATION FORM
This document is used for families without a signed lease agreement or those
on month-to-month rental agreement.
Property owners must attach a copy of their current real estate tax document
or have this form signed and notarized in the space below.
In order to comply with the J. Sterling Morton High School District’s proof of residency requirement, I verify
the following information for:
______________________________________________________________________________________
Name of Student(s)
______________________________________________________________________________________
Name of Custodian(s)/Parent(s)
I, _____________________________________________________________________________________
First and Last Name of Property Owner or landlord
am the
owner
leaseholder
landlord of the residence
located at______________________________________________________________________________
Number, Street, Apt. #
City
State
Zip
I attest that the student(s) named above and his/her custodian(s) have been living at the above address
since:
___/___/____ and to the best of my knowledge will continue to reside at this address until ___/___/______
Date
Date
Owner/Leaseholder/Landlord:_______________________________________________
Signature
___/___/______
Date
Address:_____________________________________________________________ _____-_____-______
Phone
A Notary Public needs to witness the signing of this form (please sign, date, and stamp)
Notary Public – please place your stamp in this space:
State of _______________
County of _____________
On this ________ day of _______________, in the year 20___,
before me personally comes _____________________
to me known and known to me to be the person who is described in and who executed the foregoing
instrument, and acknowledges to me that s(he) executed the same.
Signature of Notary Public______________________________
My commission expires___________________
KC/Debi Operations Common/Registration/Residency Attestation Form
Updated 03/26/2014
J. Sterling Morton High School District #201
Sirviendo a las Comunidades de Berwyn, Cicero, Lyons, McCook, y Stickney
TESTIMONIO de RESIDENCIA
Se debe de llenar este documento cuando no existe contrato de alquiler. El
dueño de la propiedad o encargado tiene que proveer una copia del predio
anual o llenar y firmar este documento ante la presencia de un notario publico.
A fin de cumplir con el requisito de comprobante de residencia del Distrito Escolar de J. Sterling Morton
High School, yo verifico la siguiente información para:
______________________________________________________________________________________
Nombre de Estudiante(s)
______________________________________________________________________________________
Nombre de Guardián(es)/Padres
Yo, ____________________________________________________________________________________
Nombre y Apellido de dueño de propiedad o encargado de la residencia
soy el
dueño
arrendatario
persona a cargo de la residencia
localizada en____________________________________________________________________________
Numero, Calle # de apartamento
Ciudad
Estado
Código postal
Yo testifico que el estudiante(s) mencionado arriba y su guardián(es) han estado viviendo en este domicilio
desde:
___/___/____ y que para mi conocimiento continuaran viviendo en este domicilio hasta ___/___/_____
Fecha
Fecha
Dueño/Arrendatario/Persona a cargo:_______________________________________
___/___/_______
Firma
Fecha
Domicilio:_____________________________________________________________ _____-____-______
Teléfono
Este documento tiene que ser firmado en la presencia de un Notario Publico.
Notary Public – please place your stamp in this space:
State of _______________
County of _____________
On this ________ day of _______________, in the year 20___,
before me personally comes _____________________
to me known and known to me to be the person who is described in and who executed the foregoing
instrument, and acknowledges to me that s(he) executed the same.
Signature of Notary Public______________________________
My commission expires___________________
KC/Debi Operations Common/Registration/Residency Attestation Form
Updated 03/26/2014