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201109462 <br /> LIVE-IN CARE ATTENDANT AFFIDAVIT <br /> I, , will be residing with as <br /> (Name of Live-in Aide) (Name of tenant) <br /> their Live-in Care Attendant. I understand that the definition of a live-in aide means a person <br /> who resides with one or more elderly persons, or near-elderly person(s), or person(s) with <br /> disabilities, and who <br /> (1) __is determined to be essential to the care and well-being of the said person; <br /> (2) is not obligated for the [financial] support of the said person; and <br /> (3) would not be living in the unit except to provide the necessary <br /> supportive services. <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 /> Under penalty of perjury, I certify that the information presented in this certification is true an� <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 /> Signature of Live-in Care Attendant Printed Name Date <br /> (Updated 12/]0) <br />