Attachment II

 

Affidavit of Dependency

 

Date:††††††††††††††† ††††††††††† †††††††††††††††††††††††††††††††††††††††††††††††††††††††††††

 

Affiant:†††††††††† ††††††††††† †††††††††††††††††††††††††††††††††††††††††††††††††††††††††††

 

Affiantís Address:†††††††† †††††††††††††††††††††††††††††††††††††††††††††††††††††††††††

 

City, State, Zip: ††††††††††† †††††††††††††††††††††††††††††††††††††††††††††††††††††††††††

 

Affiant under oath swears that the following statements are true:

 

1.†††††††† I am a parent of the Texas State University-San Marcos student listed below.

 

Studentís Name:††††††††††† †††††††††††††††††††††††††††††††††††††††††††††††††††††††††††

 

Studentís ID:†††††††††††††††† †††††††††††††††††††††††††††††††††††††††††††††††††††††††††††

 

2.†††††††† I am requesting a copy of the records listed below. I understand that Texas State may charge a fee for some records.

 

††††††††††† Records Requested:††††† †††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††

 

††††††††††††††††††††††††††††††††††††††††††††††† †††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††

 

3.†††††††† Either I or another parent of my child claimed my child as a dependent on the most recent tax return that was filed with the Internal Revenue Service.

 

4.†††††††† I understand that this affidavit is valid only for the current semester and that I must present it for each transaction.

 

 

††††††††††††††††††††††††††††††††††††††††††††††††††††††††††† †††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††

††††††††††††††††††††††††††††††††††††††††††††††††††††††††††† Parentís Signature

 

SWORN AND SUBSCRIBED TO BEFORE ME the †††††††† day of ††††††††††† ††††††, †††††††††††††††.

 

 

 

††††††††††††††††††††††††††††††††††††††††††††††††††††††††††† ††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††† ††††††††††††††††††††††††††††††††††††††††††††††† †††††††††††††††††††††††

Notary Public, State of Texas

 

 

Updated May 13, 2010