Attachment II

Affidavit of Dependency

Date:

Affiant:

Affiant’s Address:

City, State, Zip:

Affiant under oath swears that the following statements are true:

1. I am a parent of the Texas State University student listed below.

Student’s Name:

Student’s 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.

____________

Parent’s Signature

SWORN AND SUBSCRIBED TO BEFORE ME the day of ___________________, _______.

____________

Notary Public, State of Texas

Updated November 5, 2014