RENTAL ASSISTANCE AFFIDAVIT
I, [Your Name], residing at Salt Lake City, UT 84101, hereby affirm and state the following:
I am the tenant of the property located in Tucson, AZ 85701.
I am applying for rental assistance due to financial hardship caused by unexpected medical expenses and job loss.
I affirm that my household income is currently $2,500 per month and that I am unable to meet my rental obligations.
The total amount of rent due is $1,800, with a payment deadline of November 1, 2051.
I have made efforts to secure other forms of financial assistance, including applying for unemployment benefits and contacting local charities for help.
I understand that providing false information may result in penalties and denial of assistance.
Signature and Notarization
Signed on this day August 16, 2054, at Tucson, AZ 85701.
[Your Name]
Affiant
Notary Public:
Subscribed and sworn to (or affirmed) before me on this August 16, 2054, by [Your Name], who proved to me based on satisfactory evidence to be the person who appeared before me.
Notary Public
My Commission Expires: __________
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