Form B: Part I

Form B: Part I
WESTWOOD REGIONAL SCHOOL DISTRICT
701 Ridgewood Road
Township of Washington, NJ 07676
AFFIDAVIT OF RESIDENCY
STATE OF NEW JERSEY:
SS:
AFFIDAVIT
COUNTY OF BERGEN:
I, ___________________________________________, of full age, being duly sworn according to law, upon
my oath depose and say:
I am the parent/guardian of:
Name of Child(ren)
Age
Grade
School
_________________________
____
_______________
____________________________
_________________________
____
_______________
____________________________
_________________________
____
_______________
____________________________
_________________________
____
_______________
____________________________
1. I temporarily/permanently (cross out term that does not apply) reside at ____________________
___________________________ in the Borough of Westwood/Township of Washington, County of
Bergen, State of New Jersey. This has been my place of residence since ______________________.
If my residence in the premises is temporary, I plan to reside here until ______________________.
2. I do not pay rent for the premises in which I reside. I reside in the premises with the approval of
the owner/landlord whose name and address is ___________________________________________
________________________. I have attached hereto two proofs of my residence (i.e., utility/phone
bill, bank statement or insurance ID card, etc.). If such proof is not available, explain the reasons
why:
____________________________________________________________________________________
___________________________________________________________________________________.
3. I desire to register or continue to enroll my child in the Westwood Regional School District.
4. I am aware that I have the obligation to immediately notify the Westwood Regional School
District in the event I cease to be resident in the Borough of Westwood/ Township of Washington
address above.
Revised 1/25/07
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5. I hereby assume joint and several liability for any tuition assessed if my child(ren) is determined
to have been ineligible for a tuition free education in the Westwood Regional School District
during any period which he/she was allowed to attend school based on the facts contained in this
Affidavit.
6. This Affidavit is submitted for the purpose of requesting that the Westwood Regional Board of
Education accept or continue to enroll my child(ren) as a student in the Westwood Regional
School District on a tuition free basis. I state that the information contained in this Affidavit is
true and accurate and acknowledge that the Westwood Regional Board of Education will rely
upon the truthfulness and accuracy of this information. If any of the statements contained in this
Affidavit are willfully false, I am aware that I am subject to the criminal penalties provided by law
for perjury and/or false swearing, will remain subject to all other obligations and/or liabilities
which I have assumed elsewhere in this Affidavit and are imposed by applicable law, and may be
liable for the payment of tuition if it is determined that my child(ren) is ineligible for a tuition free
education in the Westwood Regional School District.
__________________________________________
Signature of Parent/Guardian
Subscribed and sworn to before me
This ___________ day of ___________________, 20
(Signed) _____________________________________
Notary Public of _____________________________
Commission Expires __________________________
(Notary Stamp with name of Notary and Seal)
Revised 1/25/07
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Form B: Part II
WESTWOOD REGIONAL SCHOOL DISTRICT
701 Ridgewood Road
Township of Washington, NJ 07676
AFFIDAVIT OF RESIDENCY
STATE OF NEW JERSEY:
SS:
AFFIDAVIT
COUNTY OF BERGEN:
I, ___________________________________________, of full age, being duly sworn according to law, upon
my oath depose and say:
1. I reside at __________________________________ in the _______________________ of
_____________________, County of Bergen and State of New Jersey. This has been my place of
residence since __________________________.
2. I own/rent (cross out term that does not apply) property located at
_______________________________ in the _______________________ of _____________________,
County of Bergen and State of New Jersey. If the property is owned, a copy of a recorded deed
showing ownership of residence or current property tax bill/statement is attached hereto. If the
property is rented, a copy of the signed lease is attached hereto or the landlord affidavit is
attached hereto.
3. ________________________________ (hereinafter referred to as a “parent”) and his/her
child(ren) by the names of ____________________________ ______________________
(hereinafter referred to as the “child(ren)”) are residing at the address listed above and have
resided there since _________________. If the parent’s residence in the premises is temporary,
he/she plans to reside there until _________________________________.
4. The parent does not pay rent for the premises in which he/she resides. He/she resides in the
premises with me on his/her own (cross out any inapplicable term) with my approval.
5. I am aware that I have the obligation to immediately notify the Westwood Regional School
District in the event the parent and his/her child(ren) cease to live with me.
Revised 1/25/07
Page 3 of 5
6. This Affidavit is submitted for the purpose of requesting that the Westwood Regional Board of
Education accept or continue to enroll the child(ren) as a student in the Westwood Regional
School District on a tuition-free basis. I state that the information contained in this Affidavit is
true and accurate and acknowledge that the Westwood Regional Board of Education will rely
upon the truthfulness and accuracy of this information. If any of the statements contained in this
Affidavit are willfully false, I am aware that I am subject to the criminal penalties provided by law
for perjury and/or false swearing, and may be liable for the payment of tuition if it is determined
that the child(ren) is ineligible for a tuition free education in the Westwood Regional School
District.
_________________________________
Signature of Owner/Landlord
Subscribed and sworn to before me
This ___________ day of ___________________, 20
(Signed) _____________________________________
Notary Public of _____________________________
Commission Expires __________________________
(Notary Stamp with name of Notary and Seal)
Revised 1/25/07
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Form B: Part III
WESTWOOD REGIONAL SCHOOL DISTRICT
701 Ridgewood Road
Township of Washington, NJ 07676
LANDLORD AFFIDAVIT
STATE OF NEW JERSEY:
SS:
AFFIDAVIT
COUNTY OF BERGEN:
I, ___________________________________________, of full age, being duly sworn according to law, upon
my oath depose and say:
1.
I am the owner of property located at __________________________________________, in the
Borough/Township of _________________________________, County of Bergen and State of New Jersey.
2.
I am renting the property to _______________________________. There is not a signed lease
which memorializes the duration or terms of the rental agreement. The tenancy commenced on
____________________________ and expires on ___________________________.
3.
I agree to furnish information on the continued tenancy of the person named in paragraph one to
the Westwood Regional Board of Education and its administration upon request.
The person signing this affidavit understands that any false statements, answers, or declarations
contained in this affidavit may subject the affiant to criminal prosecution for the crime of false swearing
in violation of 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 up to $10,000.00, or be imprisoned for up to 18 months, or both.
___________________________________
Signature of Landlord
Subscribed and sworn to before me
This ___________ day of ___________________, 20
(Signed) _____________________________________
Notary Public of _____________________________
Commission Expires __________________________
(Notary Stamp with name of Notary and Seal)
Revised 1/25/07
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