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CERTIFICATE OF RESIDENCE Cayuga County Treasurer’s Office County Office Building, 5th Floor 160 Genesee Street Auburn, New York 13021 (315) 253-1211 Eligibility: Cayuga County resident for six months, AND New York State resident for one year Certificates issued for students applying to a two year SUNY Community College located in New York State outside of Cayuga County. Guidelines: Certificate is valid for one academic year. Certificates are issued for a specific school. If you attend classes or take online classes at more than one school, a certificate is required for each school. Applications cannot be submitted sooner than 60 days before classes start and must be obtained within 30 days of classes beginning. Application Directions: 1. FILL OUT APPLICATION a. Name of Student b. Residence where Student is living (Please state full mailing address; NO P.O. Boxes) c. City, Town, or Village where Student is living d. Number of months lived at residence (1-6+ months). If a student lives at a residence for two months in the Town of Ira and five months previously in the Town of Mentz then two certificates are required to be completed to cover the 6 month period required to obtain assistance. e. List addresses lived in as required during the year immediately prior to the date of this affidavit. f. Community College or Institute in which student plans to enroll. If you plan on attending one or more during the semester you must provide an application for each college. g. Provide the semester and academic year you plan to attend (for which this application applies). h. Do NOT sign until you are in front of a Notary Public or Commissioner of Deeds. i. Please be sure to have proper photo ID. ii. A Notary Public is typically available, at no cost, in the County Treasurer’s Office. 2. The Town or City is required to verify your residence on the bottom of this form. Prior to mailing or coming to the County Treasurer’s Office this section must be completed. Take your completed form to the Town Office or City Hall for residency verification. Bring a photo ID with your residence address on it or other proof of residency. Contact the Town Office or City Hall for acceptable forms of proof. 3. EITHER: a. Mail to Cayuga County Treasurer’s Office i. Application must be notarized ii. Residency must be verified by Town or City iii. Include a self-addressed, postage paid envelope to mail to either: 1. Yourself 2. Community College or Institute b. Bring in person to Cayuga County Treasurer’s Office i. Residency must be verified by Town or City ii. Bring photo ID if form needs to be notarized. Do NOT sign unless you are in the presence of a Notary Public. ***Please note this is only the application for a certificate of residency and it needs to be submitted to your local County Government Office (Treasurer) to be processed for the actual certificate. ---PAGE BREAK--- AFFIDAVIT (OR AFFIRMATION) AND APPLICATION FOR CERTIFICATE OF RESIDENCE, PURSUANT TO SECTIONS 6301 AND 6305 OF THE EDUCATION LAW, IN CONNECTION WITH ATTENDANCE AT A COMMUNITY COLLEGE STATE OF NEW YORK ) ) SS: COUNTY OF CAYUGA ) does hereby swear (or affirm) that he/she resides at in the (City) (Town) (Village) of County of CAYUGA, State of New York; that he/she now is, and has for a period of at least one year immediately prior to the date of this affidavit (or affirmation) and application been, a resident of the State of New York; that he/she now is, or has been for a period of months within the six months immediately prior to the date of this affidavit (or affirmation) and application a resident of the County of CAYUGA; and that he/she has lived at the following places during the year immediately prior to the date of this affidavit (or affirmation) and application: Address(es) Dates (From – To) Applicant further states that he/she plans to enroll in (Community College or Institute) for the Semester beginning that this affidavit (or affirmation) and application is made for the purpose of securing from the Chief Fiscal Officer of the County of CAYUGA a certificate of residence pursuant to the requirements of Article 126 of the Education Law. Signature of Applicant Sworn to (or affirmed) before me this day of Notary Public or Commissioner of Deeds *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 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 his registration for each college year, file with the college such a certificate of residence issued not earlier than two months prior thereto, and such certificate of residence shall be valid for a period of one year from the 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 or 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 purposes of section sixty-three hundred five of this chapter, his application for a certificate of residence. **In the event that the person qualified as above for state residence, but has been a resident of two or more counties in the state during the six months immediately preceding his 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 proportional to the number of months, or major fraction thereof, of residence in each county. I, Town Clerk of the Town of do hereby certify that Mr. / Ms. has resided in the Town of for months and as a duly qualified resident is eligible to receive college charge back credit from said Town. Signed This space is for use of Chief Fiscal Officer of County Certificate Issued ( ) Certificate Not Issued ( ) Date By