Page 1 of 2WAYNE CENTRAL SCHOOL DISTRICT ● Ontario Center, New York 14520RESIDENCY AFFIDAVIT OF EMANCIPATED STUDENTSTATE NEW YORK (COUNTY OF WAYNE (TOWN OF…………… (I, the undersigned being duly sworn, depose and say that the information provided herein is true and complete to the best of my knowledge:Name………………………………………………………………………………………Date & Place of Birth……………………………………………………………………..