Certificate of Residency Form

Certificate of Residency Info / Requirements

Fill out the form below to receive a certificate of residency. To submit the online form you must upload proof of address. All documents submitted as proof of address must include the following information:

include the student’s name;
physical street address (not a PO Box); and
be dated accordingly

View Examples of Acceptable Proof of Address Documents

* Required Fields

Upload Proof of Address

Upload Files

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School*

First Name*

Middle Name

Last Name*

Email*

Re-Enter Email*

Phone*

Social Security Number or School ID (optional)

Format: 123121234 (numbers only - do not enter spaces or dashes)
Note: If you do not want to provide your SSN, please enter your school id from the previous year, or leave this field blank.

Residence Address

Street Name & Number*

Address Line 2 (apt #, etc.)

City*

State*

Zip Code*

Municipality*

Please select the specific municipality you reside in.

Is your mailing address the same as your residence address? *

Yes

Have you been a legal resident of New York State for AT LEAST ONE YEAR prior to the date of this application? *

Yes

Have you been a resident of Monroe County for AT LEAST SIX MONTHS prior to the date of this application? *

Yes

I declare that the statements made in this application have been examined by me and to the best of my knowledge and belief are true and correct. *

Monroe County, NY Adam J. Bello · County Executive

Certificate of Residency Form

View Examples of Acceptable Proof of Address Documents