Affidavit of Residency - River Edge Public Schools

River Edge Public Schools410 Bogert RoadRiver Edge, New Jersey 07661AFFIDAVIT OF RESIDENCYDate: ___________________________________I, ____________________________________, hereby affirm that I am the ___Parent / ___ Guardian andhereby certify that my child(ren) and I are officially residing at _________________________________in the Borough of RIVER EDGE, New Jersey.Students’ Names D.O.B Age Grade SchoolI further state that this form and the attached documents constitute true and accurate proof that thestudent(s) listed above reside with me within the Borough of River Edge and will continue to do so for theschool year. If any student listed above stops living with me, or if I move my residence out of River Edgewithin the school year, I will promptly notify the River Edge Public Schools.If it is determined that the above stated address is not my valid residence, I acknowledge that I will beresponsible to pay the tuition rate established by the State of New Jersey to the River Edge Board ofEducation for each child attending school in the River Edge Public School, until residency has beenestablished.The person signing the affidavit understands that any false statements, answers or declarations containedin this affidavit may subject the affiant to criminal prosecution for the crime of false swearing in violationof N.J.S.A. 2C:28-2. If a person is convicted of such a crime, he or she may be punished by a fine of upto $7,500.00, or be imprisoned for up to 18 months, or both._______________________________________________Signature of Parent/Guardian or “Affidavit Host”

FOR OFFICE USE ONLYThe following documents were received at the office which establish that the child(ren) andparent/guardian are domiciled in the Borough of River Edge (must provide one from each section -- A,B,and C).DOCUMENT NEEDED:A. An original lease, effective during the current school year ____________OR the original recorded deed or original mortgage contract showingownership of a residence within the Borough of River Edge,AND the current property tax bill/statementB. One of the following additional documents:1. Current month’s bank statement with your address(Please block out all monetary information)_____________________________________2. Current month’s Utility or Telephone Bill _____________C. A photo ID, such as a driver’s license, passport, Bergen County IDCard or employment ID card._____________Please note that additional documentation may be required.AND, IF APPLICABLE, (“AFFIDAVIT HOSTS” ONLY)D. Current signed affidavit forms stating that the student(s) listed reside(s) with for you even thoughyou are not the student’s parent or legal guardian. These affidavits are located in the school offices.Residencyaffidavitwebsite.doc