SUNY Orange   
                                                            Bursar
                           Affidavit/Application for Certificate of Residence                               

AFFIDAVIT (OR AFFIRMATION) AND APPLICATION FOR CERTIFICATE OF RESIDENCE, PURSUANT TO SECTION 6301 AND 6305 OF THE                                                              EDUCATION LAW, IN CONNECTION WITH ATTENDANCE AT ORANGE COUNTY COMMUNITY COLLEGE*


STATE OF NEW YORK,			   	 	  Semester:    Fall_________________ Spring____________________ 
COUNTY OF _______________			                                      Summer I _________II___________III______________ 


Name____________________________________________ Student ID#A________________________SS #___________________________

Address:						          			                           Dates of Residency

_______________________________________________________________________________ From____/____/_____ To____/____/_____
Street                                         	 City                      	 State       	 Zip          County

Previous (If less than 2 years at current)

_______________________________________________________________________________ From_____/_____/_____To____/____/_____


_______________________________________________________________________________ From_____/_____/_____To____/____/______


Mailing Address:________________________________________________________________________________________________________
         (If Different Than Above)

Citizenship: U.S. Citizen __________________	Other _________________  Visa Type ___________________________________ 
Permanent Resident Alien#_______________________________________     Date of Issue ________________________________          	             				ATTACH A COPY OF YOUR  PERMANENT RESIDENT ALIEN CARD (IF APPLICABLE)

I hereby swear (or affirm) that I reside at the above stated address; that I now am and have for a period of at least one year immediately prior to the date of this affidavit (or affirmation) and application; been a legal resident of the State of New York; that I now am and have been for a period of at least six (6) months** immediately prior to the date of this affidavit (or affirmation) and application, a legal resident of the County of _______________.  I further state I plan to enroll in Orange County Community College and that this affidavit (or affirmation) and application is made for the sole purpose of securing from the Chief Fiscal Officer of the County of________________________ a certificate of residence pursuant to the requirements of Article 126 of the Education Law. 
 I hereby swear (or affirm) that I reside legally at the above home address and that I have, for two years immediately prior to the date of this affidavit (or affirmation) and application, resided as stated above.

   				           		____________________________________________    ________________________
							Signature of Applicant                      	               Date
Sworn to (or affirmed) before me this                                	 
________ day  of ______________, 20________                  

________________________________________      	 
Notary Public or Commissioner of Deeds

*EDUCATION LAW, SECTION 6305, PROVIDES: �THE CHIEF FISCAL OFFICER OF EACH COUNTY, AS DEFINED IN SECTION2.00 OF THE LOCAL FINANCE LAW, SHALL UPON APPLICATION AND SUBMISSION TO HIM 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.... SUCH PERSON SHALL, UPON HIS REGISTRATION FOR EACH COLLEGE YEAR, FILE WITH THE COLLEGE SUCH A CERTIFICATE OF RESIDENCE ISSUED NOT EARLIER THAT 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 4, 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 OF SCHOOL DISTRICT, AS THE CASE MAY BE, OR A PERIOD OF AT LEAST SIX MONTHS, BOTH IMMEDIATELY PRECEDING THE DATE OF SUCH PERSON�S REGISTRATION IN A COMMUNITY COLLEGE OR , FOR THE PURPOSES OF SECTION 6305 OF THIS CHAPTER, HIS 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 OF CHIEF FISCAL OFFICER OF COUNTY
                              CERTIFICATE ISSUED(    )     CERTIFICATE DENIED(     )           DATE___________________BY_______________________                     (12/09)