Affidavit And Application For A Certificate Of Residence Form printable pdf download

PROOF OF RESIDENCE

THIS IS NOT A CERTIFICATE OF RESIDENCE

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AFFIDAVIT (OR AFFIRMATION) AND APPLICATION FOR A CERTIFICATE OF RESIDENCE

Pursuant to Sections 6301 and 6305 of the Education Law

In Connection with Attendance at a Community College*

STATE OF NEW YORK

COUNTY OF RENSSELAER

Applicant’s

Name______________________________________ does hereby swear (or affirm) that he/she resides

at________________________________________________________________________________

in the (city) (village) (town) of ___________________________ County of RENSSELAER, State of New York; that he/she

is now, and has been for a period of at least one year immediately prior to the date of this affidavit (or affirmation) and application,

been a resident of the State of New York; that he/she now is, or has been for a period of _______ months within the six months

immediately prior to the date of this affidavit (or affirmation) and application** , a resident of the County of RENSSELAER and that

he/she has lived at the following places during the year immediately prior to the date of this affidavit (or affirmation) and application:

Resided at the above address since _____/_____/_____

Other addresses during the past 12 months:

________________________________________ from______/_____/_____ to_____/_____/_____

Applicant further states that he/she plans to enroll in ___________________ County Community College and that this affidavit (or

affirmation) and application is made for the purpose of securing from the Chief Fiscal Officer of the County of RENSSELAER a

certificate of residence pursuant to the requirements of Article 126 of the Education Law.

Sworn to (or affirmed) before me this

_________ day of ______________ 20_____

_____________________________________________________

Signature of Applicant

____________________________________

Commissioner of Deeds

*Education Law, Section 6305, paragraph 3, provides, “The Chief Fiscal Officer of each county, as defined in Section 2.00 of the

local finance law, shall, upon application and submission to him/her of satisfactory evidence, issue to any person desiring to enroll in

a community college as a non-resident student, a certificate of residence showing that said person is a resident of said county:

RENSSELAER. Such person shall, upon his/her registration for each college year, file with the college such a certificate of

residence issued not earlier than two months prior thereto, and such certificate of residence shall be valid for a period of one year

from the date of issuance.”

Education Law, Section 6301, paragraph 5 defines: “Resident. A person who has resided in the State for a period of at least one year

and in the county, city, town, intermediate school district as the case may be, for a period of at least six months, both immediately

preceding the date of such person’s registration in a community college, or for the purpose of Section 6305 of this chapter, his/her

application for a certificate of residence.” ** In the event that a person qualified as above for state residence, but has been a resident

of two or more counties in the state during the six months immediately preceding his/her application for a certificate of residence

pursuant to Section 6305 of this chapter, the charges to the counties of residence shall be allocated among the several counties

proportional to the number of months, or major fraction thereof, of residence in each county.

This space for use by the Rensselaer County Bureau of Finance

Certificate Issued

Yes

Date

Affidavit And Application For A Certificate Of Residence Form

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