Hardship Statement due to COVID-19
I, ________________________________________, as of ________________________, am
(Print your full name here) (Date financial difficulty started)
experiencing financial difficulty due to the COVID-19 pandemic. My financial difficulty has led to:
A. Rent- Me not being able to pay any of my monthly rent; or
Me not being able to pay the full amount of rent I owe each month.
B. Utilities- Me not being able to pay my public utility bill in full each month.
I am experiencing financial difficulty due to:
Being laid off because of COVID-19;
Experiencing a reduction in my work hours and pay due to COVID-19;
Needing to take extended time off work due to COVID-19, either to:
Care for my child(ren) whose school is closed; or
Care for a family member who is sick with COVID-19;
Needing to take extended time off work because I have tested positive for COVID-19;
Needing to take extended time off work because I am seeking medical care to confirm if I have
COVID-19; or
Other: ____________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________.
I,_______________________________, swear or affirm that the statements above are true.
(Print your full name here)
Signed on __________________ at _____________________________________, ________.
(Date) (City) (State)
______________________________________________
(Sign your name here)
Service of form: I, ________________, gave this signed form to ________________, on ___/___/202__.
Hardship Statement Due to COVID-19
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COVID-19 Hardship Statement Instructions:
IMPORTANT:
Alaska Statute requires that this hardship statement is signed “under penalty of perjury.”
That means legal action could be taken against a person who signs the hardship form but is not
suffering from financial hardship.
Financial Hardship means that due to COVID-19, a person’s income and assets cannot
cover their own or their families food, housing, health care, and other goods/services necessary
for health and wellness. If you have lost income because of the COVID-19 emergency, and
cannot pay your rent or public utility bill as a result, then you are suffering from financial
hardship.
Instructions for using this form if you cannot pay your rent:
If you are experiencing financial hardship because of COVID-19 that makes it so you can
no longer pay your rent, you can delay eviction by filling out the “Hardship Statement,” signing it,
and providing a copy to your landlord before
June 30, 2020. Keep a copy for yourself.
This statement does not get rid of your duty to pay rent - you will still owe your full rent
for each month missed. All it does is delay any eviction hearings for nonpayment of rent until
after June 30, 2020 or until the Governor declares the COVID-19 emergency to be over
(whichever happens first).
This statement does not prevent or delay an eviction for misconduct, violation of the law,
or violations of the lease other than
inability to pay rent. The Alaska court system has postponed
all
FED actions, both new actions or actions that were already in process, until at least May 31,
2020. This does not include “emergencies” and may change. The order postponing cases will
be reviewed every two weeks. You can check for new or updated court orders on the Alaska
Court System’s COVID-19 Response Page at http://www.courts.alaska.gov/covid19/index.htm.
Instructions for using this form if you cannot pay your public utility bill:
If you are experiencing financial hardship because of COVID-19 that makes it so you can
no longer pay all of your public utility bill, you can delay utility shutoff by filling out the “Hardship
Statement,” signing it, and providing a copy to your public utility provider before
November 15,
2020 or until the Governor declares the COVID-19 emergency to be over (whichever happens
first). Keep a copy for yourself too.
You are also required to negotiate and agree to a deferred payment plan with the public
utility provider. Late fees are not permitted.
This statement does not get rid of your duty to pay your utility bill, or prevent the utility
company from collecting the money owed later on. Filling out the Hardship form and agreeing to
a payment plan means that your utility service cannot be shut off until November 15, 2020 or
until the Governor declares the COVID-19 emergency to be over (whichever happens first).
Hardship Statement Due to COVID-19
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