nnRevised 10222019Student InformationNameID InformationMarital separation is defined as a One of the partners has left the household for an indefinite period and b the marriage is severed Step One ID: 896352
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1 n n Submithis completeformnd allupportin
n n Submithis completeformnd allupportingcuments toLamartateCollegeortArthurinancial Aidfficeusingreferredethod.inancialFinancialAid@lamarpa.eduFax: 409-984-6021 Revised 10/22/2019 Student Information Name________________________________________________________________ID #________________________ Information Marital separation is defined as: (a) One of the partners has left the household for an indefinite period; and (b) the marriage is severed. Step One : Please Indicate your Proof of Seperation Legal Court Documents Verifying Separation/Divorce (i.e., complaint for divorce, legal separation, etc.)Certification and Statement of Marital Separation: Continue onto Step two Step Two: Certification and Statement of Marital Separation I, _______________________________, do hereby certify that my current marital status is separated from my spouse.I certify that we are and have continued living separated and the marriage is severed. Currently, my separated spouse residesat: PARATED SPOUSE INFORMATION (Please Print) N ddress:________________________________ ity, State, Zip:___________________________ Date of Marriage: Date of Separation: _______________________________ aa/ DD/ YYYY aa/ DD/ YYYY Divorce Intentions: Do you intend to proceed with the divorce? ____ Yes ____ No Step Three: Supporting Documentation f this is your second year claiming separation, a
2 l f this is you third year claiming sepa
l f this is you third year claiming separation you must provide Legal Court Documents Verifying Separation/Divorce (i.e., complaint for divorce, legal separation, etc.) Signatureand Certification ________________________________________________ __________________________________________________Student’sSignature DateParent’s Signature Date * The verifying person can not be the “Persons Separated” nor and the Notary Public can not be family. LAMAR STATE COLLEGE PORT ARTHUR FINANCIAL AID NOTARIZED VERIFICATION OF SEPARATION Student’s Name:___________________________ LSCPA Student ID Number: ____________________ I, __________________________, _______________________verify that _____________________________ Verifying Person Relationship to Student Person Separated and __________________________________ have been separated since _______________ _______. Person Separated Month Year ______________________________ Signature of Verifying Person ______________________________ Printed Name of Verifying Person STATE OF __________________ COUNTY OF ______________________ BEFORE ME, on this day personally appeared ______________________________ known to be the person (Name of Verifying Person) whose name is subscribed to the foregoing instrument and acknowledged to me that this person executed the same for the purpose and consideration
3 therein expressed. GIVEN under my han
therein expressed. GIVEN under my hand and official seal this the _________ day of ________________, ______. (Month) (Year) (Seal) Signature of Notary Public * The verifying person can not be the “Persons Separated” nor and the Notary Public can not be family. LAMAR STATE COLLEGE PORT ARTHUR FINANCIAL AID NOTARIZED VERIFICATION OF SEPARATION Student’s Name:___________________________ LSCPA Student ID Number: ____________________ I, __________________________, _______________________verify that _____________________________ Verifying Person Relationship to Student Person Separated and __________________________________ have been separated since _______________ _______. Person Separated Month Year ______________________________ Signature of Verifying Person ______________________________ Printed Name of Verifying Person STATE OF __________________ COUNTY OF ______________________ BEFORE ME, on this day personally appeared ______________________________ known to be the person (Name of Verifying Person) whose name is subscribed to the foregoing instrument and acknowledged to me that this person executed the same for the purpose and consideration therein expressed. GIVEN under my hand and official seal this the _________ day of ________________, ______. (Month) (Year) (Seal) Signature of Notary Publi