Information provided on this form is provisional and is subject to change after audit. Changes may affect your residency classification for fee assessment purposes. Use of this form does not assure you of the classification indicated, nor does it release you from the obligation to pay additional fees if a residency audit results in a higher assessment than the one made at registration. Please read the affidavit statement before signing at the bottom of this form.
I understand that I am allowed to register provisionally based upon my assertion that the above information is accurate and true, and should that information not be valid, my registration will be canceled. Fees will be based on a tentative residency evaluation and will be subject to change.
