AFFIDAVIT (OR AFFIRMATION) AND APPLICATION FOR CERTIFICATE OF RESIDENCE,
PURSUANT TO SECTION 6301 AND 6305 OF THE EDUCATION LAW
STATE OF NEW YORK

COUNTY OF ____________________________________

I, _________________________ (Social Security No.:___________________________)

do hereby swear(or affirm) that I

RESIDE AT: _______________________ in the City or Town of _____________________

MAILING ADDRESS:______________________________________________________

County of _____________________, State of New York: that I now am and have for a period of one year prior to the date of this affidavit (or affirmation) been a legal resident of the State of New York and have been for a period of at least six months** prior to the date of the affidavit (or affirmation) a legal resident of the County of _______________________________

* Report actual municipality of residence, NOT the postal service designation of the area.

** IF LESS THAN SIX MONTHS AT THE ABOVE ADDRESS, list your addresses for the past year:

I further state I plan to enroll in SULLIVAN 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.

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This space for use of Chief Fiscal Officer of County
Certificate Issued (   )     Certificate Not Issued(   )

Date:_______________________           By_________________________
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EDUCATION LAW, Section 6305 provides "The chief fiscal officer of each county, as defined in section 2.00 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 registration for each college year, file with the college such a certificate of residence ISSUED NOT EARLIER THAN TWO MONTHS PRIOR THERETO, and such a certificate of residence shall be valid for one year from 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, immediate school district or school district, as the case may be, for a period of at least six months, both immediately preceeding the date of such persons registration in a community college, or for the purpose 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.