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
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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 . Signature of Resi tat Owner
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(SEAL)
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EXPIRES:Nowder22,2002
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Notary Expiration Date
HADEAtARESIDENCESTR
CONFIDENTIAL Page I of I
EFTA 00071145
EFTA01247938