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 - Purchasing a Home * This Affidavit must be completed when a parent is purchasing
a home in the District (R.C. 3313.64(F)(7).

Non-Residential families who are purchasing a new house in the district will need to complete this application. In addition, a copy of the purchase agreement 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

(Please refer to UA Board Documents Section 5000 code 5111)

Sworn Statement Purchasing 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 at                                                                           , Name of Student(s)                                                               Address of New House

I am waiting to take possession upon the date of closing of the mortgage loan for the purchase. The closing date is

	. Upon closing, it is my intent to resident at the aforementioned address. I am attaching to

this statement a copy of the 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 REALTOR

I confirm that the parent named above has a contract to purchase the house Located at the address above and the parent is waiting upon the date of closing Of the mortgage loan.

Name

Name of Real Estate Broker or Bank

Date

(Please refer to UA Board Documents Section 5000 code 5111)