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I understand that providing false representations constitutes an act of fraud. False,
misleading, or incomplete information may result in the denial of my Household’s application,
the repayment of any funds received through the CERA program, or other remedies available
under law.
Identification – Self Certification for RentHelpMN
This form is to be used if the Household has no proof of identification. This form can be uploaded
to the “I have other income documents” section of the application.
Name of Applicant: ________________________________________
I do not have a form of identification that shows both a picture of me and lists my name such
as a State Issued ID, Driver’s License, Passport, Tribal ID or library card.
I affirm that the name listed is mine.
(If Electronically Signed) The typed name below serves as my electronic signature for the above
certification.
Signature of Applicant: _________________________________ Date: ____________________
