CARRABASSETT VALLEY SCHOOL DEPARTMENT
ANNUAL AFFIDAVIT OF RESIDENCY
For any school year, a student is eligible for tuition under Maine law only if the student’s parent
or guardian with legal custody actually lives in the Town of Carrabassett Valley, and the student
actually lives with that parent or guardian in the Town of Carrabassett Valley, throughout that
school year. To confirm tuition eligibility of a student, the following information must be
provided-. The Superintendent may require any other additional information at any time that
he/she feels will be helpful in making the residency determination and confirming continued
residency in the Town of Carrabassett Valley.
Father:_____________________________________ Daytime phone:________________
Mother:____________________________________ Daytime phone:________________
Legal guardian:______________________________ Daytime phone:________________
Full Legal Name and Age of Each School-Age Child Living at the Street Address Below:
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
With whom does the student reside in Carrabassett Valley? (Check all that apply)
Father

Mother

Court appointed guardian

It is required that the following information be supplied for the person(s) checked above:
Street Address: ___________________________________________________________
Mailing Address: _________________________________________________________
Email Address(s):_________________________________________________________
Home telephone: __________________________
If the student resides in the Town of Carrabassett Valley with legal guardian who is not the
student’s parent, a copy of the court order appointing the guardian must be attached to this
certificate.
If the parents of your school-aged children are living in different locations, please answer the
following questions.
A. Are the parents divorced?
B. Is there a custody agreement or court order regarding custody of the children? Please
attach a copy of the agreement or the court order that is currently in effect.
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C. If one of the parents does not live in Carrabassett Valley, please give the complete
address of that parent:
____________________________________________________________
Do you own or rent the dwelling in Carrabassett Valley (please check the appropriate line)?_
____ Own _____ Rent
If the dwelling is rented, attach a copy of the lease or rental agreement.
How long have you occupied the dwelling?
Please provide the location of any real estate you own or rent, wherever it is located and describe
how the real estate is used: ________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Address on Driver’s License:
___________________________________________________________
(Attach photocopy of license)
Issuing Town for car registration: (if you have a car) __________________________________
(Attach copy of registration)
Indicate Town in which you are registered to vote: ____________________________________
If you claim homestead exemption, indicate in which town the property is located:____________
Provide mailing address used on your most recent State and Federal Tax return:
______________________________________________________________________________
Indicate the number of days/nights per week you spend in your Carrabassett Valley dwelling
with your school-aged child(ren) during the school year: ____________________
Indicate the number of months per year you spend in your Carrabassett Valley dwelling with
your school-aged child(ren): ___________________________________________________
ALL PARENTS OR GUARDIANS HAVING PARENTAL RIGHTS CONCERNING
SCHOOL-AGED CHILDREN SEEKING SCHOOL ATTENDANCE PRIVILEGES IN
CARRABASSET VALLEY MUST SIGN THIS AFFIDAVIT.
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I CERTIFY UNDER PENALTY OF PERJURY THAT THE INFORMATION CONTAINED
HEREIN IS TRUE AND CORRECT AND THAT I ACTUALLY LIVE WITH THE STUDENT
NAMED ABOVE IN THE TOWN OF CARRABASSETT VALLEY AT THE ABOVE
ADDRESS; THAT WE WILL ACTUALLY LIVE THERE DURING THE SCHOOL YEAR,
AND THAT I AM NOT RESIDING IN ANY OTHER PLACE OR CLAIMING RESIDENCY
IN ANY OTHER PLACE FOR ANY PURPOSE OR FOR ANY OTHER STUDENT FOR THE
PURPOSE OF SCHOOL ENROLLMENT OR TUITION FOR THIS SCHOOL YEAR.
IF ANY OF THE ABOVE INFORMATION CHANGES DURING THE SCHOOL YEAR,
I WILL IMMEDIATELY BRING THE CHANGE TO THE ATTENTION OF THE
CARRABASSETT VALLEY SCHOOL DEPARTMENT.
I UNDERSTAND THAT FALSE STATEMENTS AND FALSE OATHS ARE CRIMES
UNDER MAINE LAW.
Date:_________________________ Signature:_________________________________
Print Name:________________________________
Personally appeared ____________________ and swore under penalty of perjury that all
statements made herein are true and based on his/her personal knowledge.
_______________________________________
Notary Public
Dated: ____________, 20__
______________________________________________________________________________
Date:_________________________ Signature:_________________________________
Print Name:________________________________
Personally appeared ____________________ and swore under penalty of perjury that all
statements made herein are true and based on his/her personal knowledge.
_______________________________________
Notary Public
Dated: ____________, 20__
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