Laserfiche WebLink
<br />200809274 <br /> <br />~om96 8 <br /> <br />LIVE-IN CARE ATTENDANT AFFIDAVIT <br /> <br />1, <br /> <br />, will be residing with <br /> <br />as <br /> <br />(Name of Live-in Aide) <br /> <br />(Name of tenant) <br /> <br />their Live-in Care Attendant. I understand that the definition ofa live-in aide means a person <br />who resides with one or more elderly persons, or ncar-elderly person(s), or person(s) with <br />disabilities, and who <br /> <br />(1) _ is determined to be essential to the care and well-being of the said person; <br /> <br />(2) _ is not obligated for the [financial] support of the said person; and <br /> <br />(3) _ would not be living in the unit except to provide the necessary <br />supportive services. <br /> <br />Please initial the above items that are applicable and provide verification of need from <br />applicant/tenant's health care professional or case manager. <br /> <br />Under penalty of perjury, I certify that the information presented in this certification is true and <br />accurate to the best of my knowledge. The undersigned further understands that providing false <br />representations herein constitutes an act of fraud. False, misleading or incomplete information <br />may result in the termination of a lease agreement. <br /> <br />Signature of Live-in Care Attendant <br /> <br />Printed Name <br /> <br />Date <br /> <br />(Updated I 1107) <br />