Affidavit of Domicile of Parent/Legal Guardian

STATE OF NORTH CAROLINA. COUNTY OF CHEROKEE. Regarding: Student's Full Name*

Answer required for "STATE OF NORTH CAROLINA. COUNTY OF CHEROKEE. Regarding: Student's Full Name"

I state under oath that the following facts are true and correct:

My name is:*

Answer required for "My name is:"

My street address is:*

Answer required for "My street address is:"

My mailing address is:*

Answer required for "My mailing address is:"

My home and work telephone numbers are:*

Include area code for each. For example: Home: (828) 332-5555. Work: (828) 557-3456.

Answer required for "My home and work telephone numbers are:"

What is your email address?*

Answer required for "What is your email address?"

I am:*

Answer required for "I am:"

The parent of the child listed above.

The legal guardian of the child listed above.

Other:

Attached to this affidavit is verification of my residency in Cherokee County.*

Answer required for "Attached to this affidavit is verification of my residency in Cherokee County."

Utility Bill

Residency Verification

Purchase Agreement

Phone Bill

Lease Agreement

Drivers License

Citizenship Card

I understand that if the information in this affidavit is false, the child may be removed from school.*

Answer required for "I understand that if the information in this affidavit is false, the child may be removed from school."

I understand.

WARNING OF PENALTY

I UNDERSTAND THAT IF THE INFORMATION CONTAINED IN THIS AFFIDAVIT IS FALSE, THE LOCAL BOARD MAY, UNLESS THE STUDENT IS OTHERWISE ELIGIBLE FOR SCHOOL ATTENDANCE UNDER OTHER LAWS OR SCHOOL BOARD POLICY, REMOVE THE STUDENT FROM THE SCHOOL. THE BOARD WILL GIVE NOTICE OF AN OPPORTUNITY TO APPEAL THE REMOVAL IN ACCORDANCE WITH THE APPROPRIATE POLICY OF THE LOCAL BOARD.

I UNDERSTAND THAT IF I HAVE WILLFULLY AND KNOWINGLY PROVIDED FALSE INFORMATION IN THIS AFFIDAVIT, I AM GUILTY OF A CLASS 1 MISDEMEANOR AND MUST PAY TO THE LOCAL BOARD AN AMOUNT EQUAL TO THE COST OF EDUCATING THE STUDENT DURING THE PERIOD OF ENROLLMENT.

____________________________________________________________________________________________________________________________

County of: ____________________________________________

Sworn Under Oath or Affermation.

__________________________________________________

Signature of Parent/Legal Guardian

SWORN TO AND SUBSCRIBED BEFORE ME

This ____day of __________________, 20________.

by _____________________________________________________________

(Print name of parent, guardian, or legal custodian)

________________________________________________ (Notary Seal)

(Signature of Notary Public)

My Commission Expires:_______________________

Please do not use the SUBMIT button for this affidavit. It must be printed, and you must sign the affidavit in the presence of a notary public. Once this requirement is fulfilled, you may deliver the affidavit to the principal of your student's school.

Please fix the highlighted areas below before submitting.

Affidavit of Domicile of Parent/Legal Guardian