Crry OF HARTFORD | AFFIRMATION OF RESIDENCY FORM. ‘The City of Hartford requires thet you continuously maintain a bona fide residence in the City of Hartford during. your time of employment. For the purposes of this request “BONA FIDE” is defined as (1) a physical mailing address at which you reside (a post office address does not qualify); (2) be « registered Hartford voter; and (3) if the employee owns a motor vehicle, the motor vehicle nmst be registered in the City of Hartford, ‘Pursuant to the Hartford Municipal Code, Section 2-850: All council and Mayor appointecs and unclassified. ‘amployees employed by the City, shall maintain a continuous residence in the City during the period of such ‘appointment or employment. ‘You are required to complete and submit this Affirmation of Residency form anmally. You may also be required to submit supporting documentation, as the Director of Human Resources may require. ‘This documentation will bbe subject to verification. understand that the following actions will take place, “Ifsuch individual ceases to be a bona fide resident of the City once the residency has been established or fails to become a bona fide resident within six (6) months of the appointment or employment, the Council shall, by a vote of seven (7) members, send notice to the mayor that pursuant to the provisions of Chapter V, section 3(6) of the Hartford Charter, the office or position of the individual who has failed to remain a bona fide resident of Harford shall thereupon become vacant, and such appointment or employment shall terminate.” NOTICE: THE EMPLOYEE BEARS THE BURDEN TO SHOW LEGAL DOMICILE. ANY FALSE OR MISLEADING STATEMENTS WILL RESULT IN IMMEDIATE DISQULATFICATION OR DISMISSAL. 1 J hereby attest that I am a bona fide resident of the City of Hartford, nea Montane? , ‘Please print name) my address is oy Lav Bt. $40 . Complete all statements. 7 1 1 ownfentn the City of arfond (C1 Lo not live in the City of Hartford. 2. EV tem a rghacst ome ts Cy ot ti ‘Lam not a registered voter in the City of Hartford. 3. ‘Do you own (a) motor vehicle(s)? Yes No [s your motor vehicle registered in the City of Hartford? a Do Thereby certify that ALL statements made by me on this form are true, complete and correct, I understand and hat if [make any false or misleading statements of fact, am subject to immediate dismissal and to such 1444, — FOR OFFICE USE ONLY: Residency Verified by (Please print name): Date: Revised December 5, 2014