County of Suffolk Affidavit and Application for Certificate of Residence
10/07 rev.
AFFIDAVIT (OR AFFIRMATION) AND APPLICATION FOR CERTIFICATE OF RESIDENCE,
PURSUANT TO SECTION 6301 AND 6305 OF THE EDUCATION LAW, in connection to
Attendance at
(Name of Community College)
(Check all that apply) Full Time
□
Part-Time
□
On-Line
□
Overseas
□
Special
□
STATE OF NEW YORK, Semester
COUNTY OF SUFFOLK
Name: Social Security No
Daytime Phone#:
Addresses:
Dates of Residency
From To Present Date
Street City State Zip
From To
Street City State Zip
From To
Street City State Zip
Mailing Address:
(If Different Than Above)
Citizenship: United States Citizen □ Visa Type Resident Alien #
I hereby swear and 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 Suffolk. I further state I plan to enroll in
(Enter name of 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 Suffolk a certificate of residence pursuant to the requirements of Article 126 of the Education
Law.
(Signature of Applicant) (Date)
Sworn to (or affirmed) before me this This space for use of Chief Fiscal Officer of Suffolk County
day of 20
Certificate Issued ( ) Certificate Denied ( )
Date
Notary Public
By
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 certificate of residence issued not earlier than two months prior thereof, and such 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, intermediate school district, as the case may be, for a period of at least six months, both immediately preceding the date of
such person’s registration in a community college, or for the purpose of Section Sixty-Three Hundred Five of this chapter, his application of a
certificate of residence.
**In the event that a person qualified as above for a 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 Sixty-Three Hundred Five of this chapter, the
charges to the counties of residence shall be allocated among the several counties proportioned to the number of months, or major fraction
thereof, of residence in each county.
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