CARY Y COMM MUNITY Y CONS SOLIDA ATED S SCHOO OL DIST TRICT 211 15 Crystal Lake e Rd  Cary, I llinois 60013  224-357-510 00  Fax 847--639-3898

Proof of Residen ncy S Student Nam me L LEGAL First

Mid ddle

LE EGAL Last

Grad e

School

In-District Add dress C Current Mailin ng Address S Subdivision Iff moving after school starts, provide mo oving date C Current Phone e#

(home e)

(work)

M Must present a certified or registered birrth certificate for the stude nt. M Must present proof of resid dency within th he District by providing the e required num mber of documents from e each of the following categories: c C Category I (O One documen nt required)      

Most M recent prroperty tax bill and proof off payment, e.g g., canceled ccheck or Form m 1098 (home eowners) Mortgage M pape ers (homeown ners) Signed and da ated lease and d proof of lastt month’s payyment, e.g., ca anceled checck or receipts (renters) etter from ma anager and prroof of last mo onth’s payme ent, e.g., cancceled check or receipt Le Le etter of reside ence from lan ndlord in lieu of o lease Notarized N distrrict residence form must be e used when the person se eeking to enro oll a student iis living with w a District resident r C Category II (T Two docume ents showing g proper address are req uired)          

Driver’s D license e Vehicle V registration Voter V registratiion Most M recent ca able television n and/or crediit card bill Current C public aid card Current C homeo owners/renterrs insurance policy p and pre emium payme ent receipt Most M recent ga as, electric, an nd/or water bill Current C library card Receipt R for mo oving van renttal Mail M received at a new residences

W Warning and Affirmation Illinois law has s made it a crrime, punisha able by imprisonment and ffine, to knowingly or willfully present any false in nformation re egarding the residency of a student for purposes p of e enabling that sstudent to atte end on a tuitio on-free b basis or to kno owingly enroll or attempt to o enroll a stud dent on a tuitiion-free basiss when the student is know wn to be n non-resident of o the District. The Districtt will seek pro osecution to th he full extent of the law any person who o the D District believe es has comm mitted any resiidency-related d crime. Add itionally, the D District may in nitiate a civil llawsuit.

P Parent/Guardian Signature e O Office Use Only: Start Date ___ ____________

Date Accepted by _____________ _