Verification of Residency

Verification of Residency for attendance at Western Pines Community Middle School RESIDENT OWNER: Please present two proofs of address (utility bill, voters registration, vchkle title) and your drivers license to a notary public along with the letter below. PARENT/GUARDIAN: Please accompany the resident owner to obtain the signature of a notary public on the letter below. Parent/Guardian must provide a drivers license. It is the responsibility of the parent/guardian to nod& the school in the event of any change in address/residency. This signed and notarized letter will be in effect for no longer than on:: ;chats' year. A r.tr.v 1.4:::.•7 1:Thmittrt! ?ad+ rtr Date: /006, J / 1,99 C") ent/guardianof_j nt) affirm that my student resides with/without (circle one) . at the address noted below. I 7 -be 6 1 . fpf,./P7 , affirm that said student/student & family (circle one) reside with me at the ad (ess listed below: L. 5 7 9 2 N. „Zsageanarteis_e_7.___,I1S_a nature of Paren tan 1. N Q. aco • c (SEAL) cs‘. (DM-M- 0 "OM AiR01181AY MY0CI0NSI0NS0CN2574 EXPIRES:Nowder22,2002 BatladlbraftyPtOkUi0,innieel HADEAtARESIDENCESTR . Signature of Resi tat Owner c~DlYc-t-32-`-ten Notary Expiration Date CONFIDENTIAL Page I of I EFTA 00071145 EFTA01247938