Notarized Rental Agreement by nrt31881

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									                                                                 Denver Public Schools
                                    OFFICE OF ADMISSIONS – STECK ELEMENTARY SCHOOL
                                                   450 Albion Street, Denver, Colorado 80220
                                                                          Tel (303)-355-7314
                                                                         Fax (720)-424-3895
                                                                             www.dpsk12.org

Steck Elementary School
Resident Renter / Lessee Registration and Verification of Residency
This form must be completely filled out and notarized prior to approval.

Resident Lessee / Renter Information:                                               Date:__________________

Parent / Guardian Name(s):______________________________________________________

Student Name(s): ______________________________________________________________

Address: ____________________________________, ___________________, ____________
                   (Street)                          (City)           (Zip Code)
Home Phone Number: ____________________ Cell Phone Number(s): _________________

Proof for Residency Provided:

        □ Current signed Lease / Rental Agreement; AND
        □ A NOTARIZED letter from the landlord verifying Lease / Rental Agreement; AND
        □ Utility Bill- Gas or Electric ONLY last or current month

□       I hereby confirm the student(s) listed above resides at the above address
        which is within the Steck Elementary School boundaries.
Under penalty of perjury, I affirm that all information given above is true and correct. I further
understand and agree that, if it is later determined that this family is not a legal resident within the Steck
Elementary School boundary, such students may be withdrawn from Steck Elementary School. I further
agree to pay Steck Elementary School any and all applicable tuition charges that may be due, together
with the cost of collection thereof, including reasonable attorney’s fees. A person commits perjury in the
second degree if, he or she makes a statement with an intent to mislead a public servant in the
performance of his duty.
                                                                           Colorado Revised Statutes, Sec l18-8-503, 108-1-106


_____________________________                                 ____________________________________
   (Resident Renter / Lessee)                                        (Resident Renter / Lessee)



        Subscribed and sworn to before me this ______ day of ___________________, 20____.
                                  ________________________________________________
                                                       (Notary Public)
                 My Commission Expires: _____________________________

								
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