UPPER ARLINGTON SCHOOLS S E R V E • L E A D • S U C C E E D

Central Registration
1619 Zollinger Rd, Upper Arlington, OH 43221 614-487-5220 EXT 1105

Application for Temporary Residence Waiver - Building a Home * This Affidavit must be completed when a parent is Building
a home in the District (R.C. 3313.64(F)(7).

Non-Residential families who are building a new house in the district will need to complete this application. In addition, a copy of the purchase contract/builder’s contract showing the future owner’s name, address and expected occupancy date must be attached to the application. The buyer/purchaser will have 90 calendar days from the date of enrollment to establish residency in the school district. Tuition will begin on the 91st day.
Please list students below: 1.
2. 3. 4. 5. 6.

Parent/Guardian Name: 	

Parent/Guardian Current Address: 	

** Please attach a copy of your purchase agreement

Future Address: 	

Builders or Realtor’s Contact Information: 	

Builders phone number: 	

Builders Company: 	

Possession date: 	

Office use:
	Application Approved

	Sworn Statement Signed and Notarized
	90 Day Expiration Date 	

Tuition Free 90 Days

	Purchase Agreement
	Application Denied

Sworn Statement Building a New Home

State of Ohio	)

) SS: County of Franklin)

	, being duly sworn on oath, deposes and says: (Name of Parent/Guardian)

I am the parent of		, I am purchasing a house that is being Name of Student(s)
Built at		, I am waiting to take Address of New House

Upon completion, it is my intent to reside at the aforementioned address.

I am attaching to this statement a copy of the building contract or purchase contract.

Further affiant sayeth naught.

Signature of Parent/Guardian

SWORN to and SUBSCRIBED in my presence this	day of	, 20 .

Notary Public

STATEMENT of BUILDER

I confirm that a new house is being built for the parent named above and that the house Is in the location
indicated in the statement above.

Name

Name of Builder

Date