Petition to Claim Missouri Residency
MSSU Student ID
Date of Birth (MM/DD/YYYY
Permanent Missouri Address:
How long have you lived at this address?
Parents' Address (if under age of 21)
Former State of Legal Residence
Period of Uninterrupted Residence in Missouri : from _________ to Present
Term and Year First Entered MSSU:
I am requesting Missouri Residency for: (select one)
I declare that all information provided related to this request is accurate to the best of my knowledge without evasion or misrepresentation.
Please Type Full Name
For the consideration of my residency request, I volunteer the following information with the understanding that "clear demonstration" and "persuasive evidence" of the establishment of residence may include the following facts, but their existence alone shall not be deemed to be conclusive evidence of residence.
1. AUTOMOBILE INFORMATION
(proof of registration required)
an automobile that belongs to another person.
own or drive an automobile regularly
State in which automobile is licensed:
If automobile belongs to another person, list name of owner:
2. DRIVER'S LICENSE INFORMATION
possess a motor vehicle operator's license
I do possess a motor vehicle operator's license
State in which valid motor vehicle operator license was issued by:
3. INCOME TAX INFORMATION
file a Federal Income Tax return for the past year.
I did file a Federal Income Tax return for the past year.
State for which Federal Income Tax was filed:
4. INCOME TAX INFORMATION
file a State Income Tax return for the past year.
I did file a State Income Tax return for the past year.
State for which State Income Tax was filed:
5. PERSONAL PROPERTY AND/OR REAL ESTATE TAX INFORMATION
pay personal property tax for the past year.
I did pay personal property tax for the past year
pay a real estate tax for the past year.
I did pay a real estate tax for the past year.
State in which personal property and/or real estate taxes were paid:
6. VOTER REGISTRATION INFORMATION
registered to vote.
I am registered to vote.
State of Voter Registration:
7. HOUSING INFORMATION
I live on campus.
I own a house.
I rent an apartment or house.
Lease Agreement Start/End Dates:
8. PARENTAL FINANCIAL ASSISTANCE INFORMATION
receiving financial assistance from my parent(s).
My parents' did
list me as a dependent on their last Federal Income Tax return.
(Attach copy of pg 1 from parent's W1040)
My parent's income was taken into account in determining financial aid for the current academic year.
My parents' income was
taken into account in determining financial aid for the current academic year.
consider myself "emancipated" from my parent(s).
I do consider myself "emancipated" from my parent(s). Please provide reasons and proof below.
Reason for "emancipated" claim:
"Empancipated" in this context means "A student whose parent(s) have entirely surrendered the right to the care, custody, and earnings of such student, and who no longer are under any legal obligations to support such a student."
9. EMPLOYMENT INFORMATION :
Please list all the places you have worked in Missouri since arriving in Missouri. Include Place, start date, end date (if applicable) and full time/part time status.
If currently working, please submit a letter from employer stating hire date, full or part time status, and how long employment is expected to last.
Provide any additional information you think should be considered in connection with this petition.
By typing my name below, I swear or affirm the truthfulness and accuracy of the statements made in this application and that the documents provided are genuine and have not been altered. I understand and agree that if MSSU determines that I have not been truthful, accurate, and honest in completing this application for residency I can be assessed non-resident fees even for semesters that have been completed.
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