Exhibit O - DOC by ebg70110

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									                                                                                                                                                   Exhibit O
                                                    Child Support/Alimony Self Affidavit
Applicant/Tenant:                                                                 Property:
This form verifies the receipt/non-receipt of child support for the following children:




Owners must count alimony or child support amounts awarded by the court unless the applicant certifies that
 payments are not being made and that he or she has taken all reasonable actions to collect amounts due,
       including filing with the appropriate courts or agencies responsible for enforcing payment.
1.   I do not receive court ordered alimony    and/or child support                                       . Reason why:                   (Must state
why and then no further documentation is required).
2.     I receive the full amount of alimony    child support    in the amount of $      a week                                                     month
     year    (further documentation is not available). Reason why documentation is not available:                                                     .
3.    I do not receive the full award amount of alimony       and/or child support    and do receive the
amount or sporadic amount of $          a week     month       year    (divorce decree, separation statement,
child support enforcement order, payment sheet from an enforcement agency, and legal attempts to collect is
required and if not obtained the full amount of the original order must be used).
4.    I do not receive the full award amount of alimony      and/or child support    and do receive the
amount or sporadic amount of $          a week      month     year    and supporting documentation is not
available. Please explain why:         (Failure to provide documents and proof of reasonable attempts to
collect could be a reason for denial).
               The applicant/tenant agrees to notify the owner/management company if there is any change in the
               status of the alimony/child support.
               The applicant/tenant agrees that the owner/Corporation does not have to permit the tenant’s
               signed/sworn statement indicating the applicant/tenant is not receiving alimony/child support
               payments if a reasonable person in the owner’s/Corporation’s position would conclude that the
               applicant’s/tenant’s income is higher than the represented income.
               The applicant/tenant understands that the Corporation’s or Owner’s monitoring procedure may
               require other documentation other than what is stated above.
I/WE certify under the penalty of perjury that all information I/We provided for the purpose of completing
this form is true and complete to the best of My/Our knowledge and belief. I/We understand that willful
misrepresentation of any information provided herein constitutes fraud and may be dealt with in a Court of
Law.


Tenant Signature                                           Date                   Tenant Signature                                               Date


Manager’s Signature                                        Date
Note: Section 1001 of Title 18 of the U.S. Code makes it a criminal offense to make willful false statement or misrepresentations to any Department or Agency of
the United States as to any matter within its jurisdiction.


KHRC HTC EXHIBIT O (SELF AFFIDAVIT) 1-1-07

								
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