I, [Your Name], of Virginia Beach, VA 23450, being duly sworn, hereby declare the following:

1. Purpose: This affidavit is made to apply for rental assistance due to financial hardship caused by unforeseen circumstances.

2. Personal Information:
   a. Full Name: [Your Name]
   b. Address: Virginia Beach, VA 23450
   c. Phone Number: (555) 123-4567
   d. Email: [Your Email]

3. Income Information:
   a. Current Employment Status: Unemployed
   b. Monthly Income: $0
   c. Additional Sources of Income: Unemployment benefits ($1,200/month)

4. Financial Hardship:
   I declare that I am experiencing financial hardship due to:

   • Job loss from the September 2051 company downsizing.

   • Medical expenses incurred from a recent surgery that totaled $5,000.

   • Increased living costs due to inflation impact my ability to pay rent.

5. Rental Information:
   a. Landlord's Name: Garfield Williams
   b. Property Address: Raleigh, NC 27601
   c. Monthly Rent Amount: $1,200

6. Assistance Request:
   I am requesting rental assistance for $1,200 to cover my rent due for December 2051. This assistance will allow me to maintain housing while I seek new employment and recover from medical expenses.

7. Affirmation:
   I affirm that the information provided in this affidavit is true and accurate to the best of my knowledge and belief.

Signature and Notarization

Signed on this day October 21, 2051, at Raleigh, NC 27601.

[Your Name]
Affiant

Notary Public:

Subscribed and sworn to (or affirmed) before me on this October 21, 2051, 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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