Fillable Printable County of Suffolk Affidavit and Application for Certificate of Residence
Fillable Printable County of Suffolk Affidavit and Application for Certificate of Residence
County of Suffolk Affidavit and Application for Certificate of Residence
10/07 rev.
AFFIDAVIT (OR AFFIRMATION) AND APPLICATION FOR CERTIFICATE OF RESIDENCE,
PURSUANT TO SECTION 6301 AND 6305 OF THE EDUCATION LAW, in connection to
Attendance at
(Name of Community College)
(Check all that apply) Full Time
□
Part-Time
□
On-Line
□
Overseas
□
Special
□
STATE OF NEW YORK, Semester
COUNTY OF SUFFOLK
Name: Social Security No
Daytime Phone#:
Addresses:
Dates of Residency
From To Present Date
Street City State Zip
From To
Street City State Zip
From To
Street City State Zip
Mailing Address:
(If Different Than Above)
Citizenship: United States Citizen □ Visa Type Resident Alien #
I hereby swear and affirm that I reside at the above stated address; that I now am and have for a period of at least one
year immediately prior to the date of this affidavit (or affirmation) and application; been a legal resident of the State of
New York; that I now am and have been for a period of at least six (6) months** immediately prior to the date of this
affidavit (or affirmation) and application, a legal resident of the County of Suffolk. I further state I plan to enroll in
(Enter name of Community College)
and
That this affidavit (or affirmation) and application is made for the sole purpose of securing from the Chief Fiscal
Officer of the County of Suffolk a certificate of residence pursuant to the requirements of Article 126 of the Education
Law.
(Signature of Applicant) (Date)
Sworn to (or affirmed) before me this This space for use of Chief Fiscal Officer of Suffolk County
day of 20
Certificate Issued ( ) Certificate Denied ( )
Date
Notary Public
By
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 to 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 registration for each
college year, file with the college such certificate of residence issued not earlier than two months prior thereof, and such certificate of residence
shall be valid for one year from 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, 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 purpose of Section Sixty-Three Hundred Five of this chapter, his application of a
certificate of residence.
**In the event that a person qualified as above for a state residence, but has been a resident of two or more counties in the state during the six
months immediately preceding his/her 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 proportioned to the number of months, or major fraction
thereof, of residence in each county.
10/07 rev.
Guidelines for Suffolk County Certificate of Residence
QUALIFICATIONS:
1.
Resident of New York State for at least one (1) full year immediately preceding the date the
application/affidavit is notarized.
2.
Resident of Suffolk County for at least six (6) months immediately preceding the date the
application/affidavit is notarized.
3.
US Citizen or Permanent Resident Alien for at least one (1) full year immediately preceding the date
the application/affidavit is notarized.
TIMELINESS REQUIREMENTS:
1.
Submit application/affidavit to Suffolk County no earlier than sixty (60) days before the official start
date of the semester and no later than thirty (30) days after the official start date of the semester.
2.
The date the application/affidavit is notarized must be no earlier than thirty (30) days before the date
Suffolk County receives the application/affidavit. We suggest that you have your
application/affidavit notarized just before you mail it to Suffolk County.
TO APPLY:
1.
Download affidavit/application form at
or obtain from the school you are attending.
2.
Complete affidavit/application form in its entirety. Print legibly in blue or black ink or type all
information. Do not leave any spaces blank.
3.
Have the affidavit/application notarized. Suffolk County does not notarize the form. Make sure the
notary stamps, dates, and signs his/her name on the affidavit/application. The notary may not be a
relative or a person with the same last name as yours.
4.
Permanent resident aliens must submit a copy of the front and back of a valid permanent resident
alien card that was issued to you at least one (1) year ago.
5.
Two (2) forms of proof of address must accompany your application. The proof must be in the
student’s name and reflect his/her current address. Proof with a PO Box address in not acceptable
(except for NYS income tax returns). Your proof must reflect an actual physical address. You may
submit photocopies of your proof; however, the notarized affidavit/application must be an original.
If you received a certificate of residence from Suffolk County for the prior school year, you only
have to submit Proof #2 for Suffolk County residency. Please note on the affidavit/application that
you received a certificate of residence for the prior school year.
www.suffolkcountyny.gov/upload/comptroller/pdfs/coraffidavit2.pdf
10/07 rev.
Proof #1 – New York State Residency
In order to prove you have been a resident of New York State for at least one (1) year, you must
submit one of the following documents that must be dated at least one (1) year prior to the date your
affidavit/application is notarized but not dated more than 2 years ago.
Example: Your affidavit/application was notarized on Sept. 1, 2007. Your proof must be dated
between Sept. 1, 2005 and Sept. 1, 2006.
•
Drivers license
•
Learners permit
•
Auto registration
•
Selective service card
•
Voter registration ID card (not polling place reminder card)
•
High school report card
•
High school transcript (unofficial is acceptable)
•
New York State income tax return (IT-150 or IT-201)** – first page and signature page
only. Attach copy of W-2.
**Federal 1040 income tax return is not acceptable. If you do not file a NYS tax return and
your parents claim you as a dependent on their tax returns, you must submit a copy of the first
page and signature page of their Federal 1040 income tax return and their NYS income tax
return with a copy of their W-2 attached.
**Keep in mind that we use the filing date of the tax returns not the tax year for which they
are filed. For example: 2006 tax returns are filed in 2007 and would not be a year old until 2008.
Proof #2 – Suffolk County Residency
In order to prove you have been a resident of Suffolk County for six (6) months, you must submit one
of the following documents that must be dated within the six (6) months immediately preceding the
date your affidavit/application is notarized.
Example: Your affidavit/application was notarized on Sept. 1, 2007. Your proof must be dated
between March 1, 2007 and Aug. 31, 2007.
•
TAP award
•
Financial aid (FAFSA)
•
Student Loan
•
Bank statement
•
Credit card statement
•
Cell phone bill
•
Utility Bill
•
Any of the documents listed under Proof #1 if dated within preceding 6 months.
10/07 rev.
6.
Mail the original, notarized affidavit/application*, copies of proof #1 and proof #2, copy of resident
alien card if applicable, and a self-addressed, stamped envelope to the following address.
Applications are accepted by mail only.
Suffolk County Dept. of Audit & Control
Attn: Certificate of Residence, 8
th
Floor
100 Veterans Memorial Hwy
PO Box 6100
Hauppauge, NY 11788-0099
*Please make a copy of the affidavit/application for your records.
7.
It will take at least ten (10) business days to process your affidavit/application. Once processed, the
certificate of residence will be mailed to you. You are responsible for then submitting the certificate
of residence to the college you are attending.
