"Proof of Residency Form (Web Site) - Jackson-Milton Local School District" - Jackson County, Missouri

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Proof of residency form (web site)
_________________________________________________________________________________________
Student’s Name
Birth Date
Grade
Sex
LEGAL ADDRESS
_________________________________________________________________________________________
Number Street
Telephone/Home
_________________________________________________________________________________________
City
State
Zip
Telephone/Work
I certify that I, the parent/guardian of the above student are residents of the Jackson-Milton Local School District
or for open enrollment in an adjacent school district, and we reside at the address indicated. Residency is
defined as the location at which you and the child sleep and eat most meals. IT IS A CRIMINAL OFFENSE
SUBJECT TO FRAUD CHARGES TO FALSIFY RESIDENCY.
_________________________________________________________________________________________
Signature of Parent/Guardian
Date
ADDITIONAL INFORMATIONAL/MATERIALS REQUIRED BY STATE LAW
1.
Birth certificate of child being enrolled
2.
Proof of grade placement – current report card or school records
3.
Proof of Child Custody or guardianship (if applicable)
4.
Proof of Immunization
5.
Proof of Social Security Number
Please circle and attach photocopies of appropriate documentation – one from each column.
Column 1
Column 2
1.
House Closing Papers
1.
Two current utility bills
2.
Deed
2.
Two current charge statements
3.
Mortgage Documents
3.
Drivers License
4.
Building Permit
4.
Tax statement
5.
Rental Agreement/Lease
6.
Notarized Parent Residency
Affidavit
(on back)
FOR OFFICIAL USE – TO BE COMPLETED BY SCHOOL ADMINISTRATOR
APPROVED FOR ENROLLMENT _____
TEMPORARY APPROVAL ______
_________________________________________________________________________________________
School
Signature of Administrator
Date
Proof of residency form (web site)
_________________________________________________________________________________________
Student’s Name
Birth Date
Grade
Sex
LEGAL ADDRESS
_________________________________________________________________________________________
Number Street
Telephone/Home
_________________________________________________________________________________________
City
State
Zip
Telephone/Work
I certify that I, the parent/guardian of the above student are residents of the Jackson-Milton Local School District
or for open enrollment in an adjacent school district, and we reside at the address indicated. Residency is
defined as the location at which you and the child sleep and eat most meals. IT IS A CRIMINAL OFFENSE
SUBJECT TO FRAUD CHARGES TO FALSIFY RESIDENCY.
_________________________________________________________________________________________
Signature of Parent/Guardian
Date
ADDITIONAL INFORMATIONAL/MATERIALS REQUIRED BY STATE LAW
1.
Birth certificate of child being enrolled
2.
Proof of grade placement – current report card or school records
3.
Proof of Child Custody or guardianship (if applicable)
4.
Proof of Immunization
5.
Proof of Social Security Number
Please circle and attach photocopies of appropriate documentation – one from each column.
Column 1
Column 2
1.
House Closing Papers
1.
Two current utility bills
2.
Deed
2.
Two current charge statements
3.
Mortgage Documents
3.
Drivers License
4.
Building Permit
4.
Tax statement
5.
Rental Agreement/Lease
6.
Notarized Parent Residency
Affidavit
(on back)
FOR OFFICIAL USE – TO BE COMPLETED BY SCHOOL ADMINISTRATOR
APPROVED FOR ENROLLMENT _____
TEMPORARY APPROVAL ______
_________________________________________________________________________________________
School
Signature of Administrator
Date