Page 1 of 2WAYNE CENTRAL SCHOOL DISTRICT ● Ontario Center, New York 14520RESiDENCY AFFIDAVIT OF PARENT(S)STATE NEW YORK (COUNTY OF WAYNE ( ss.:TOWN OF …………….(I (we), the undersigned, being duly sworn, depose and say that: I (we) am (are) the parent (s) of the student named below and certify that the information provided herein is true and complete to the best of my (our) knowledge:1) Student’s Name: ……………………………………………..Grade (20…-…)……………………….
2) Student’s Date & Place of Birth: …………………………………………….Age…………………..
]3) Student’s Present Full-Time Address:
……………………………………………………………………………………………………………….
4) Name & Address of Student’s Father:
…………………………………...
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