PENNRIDGE SCHOOL DISTRICT 1200 N Fifth Street Perkasie, Pennsylvania 18944-2295

Dr. Jacqueline A. Rattigan District Superintendent

Ms. Michelle Burkholder Director of Pupil Services 215-453-2785

RESIDENT AFFIDAVIT OF MULTIPLE OCCUPANCY 2016/2017 SCHOOL YEAR Date _________________ I, _________________________________, certify that I am the legal owner or lessee of the property at

______________________________________________________________________________________

which is located in the Pennridge School District.* I further swear that

______________________________________________________________________________________ Names of Parent(s) and Child(ren) that are residing with you at the above address

are living on a permanent basis at the above address. I assume responsibility for notifying the school district should the above circumstances change.

I am aware that the facts as stated above are subject to

investigation, and should it be determined that the above is not a true statement of fact, either now or in the future, I shall then be liable to reimburse the Pennridge School District at the annual tuition rate (stated below) for improper attendance in the Pennridge School District.

______________________________________ Signature of Owner or Lessee ______________________________________ Relationship to New Resident ______________________________________ Telephone Number

______________________________________ Notary Public Seal and Stamp

The tuition rate is calculated by Pennsylvania Department of Education based on the previous year’s Financial Report as reported by each School District. As a result, the 2016/2017 tuition rate is based on the 2015/2016 school year with an adjustment made on the June tuition bill. The estimated tuition rates for the 2016/2017 academic year are as follows:

Elementary

$9,648.97 (Kindergarten rate is ½ Elementary rates.)

Secondary

$13,121.21

.