PRINCE GEORGE’S COUNTY
COVID-19 EMERGENCY RENTAL ASSISTANCE PROGRAM
LANDLORD
ATTESTATION DOCUMENTING TENANT RESIDENCY
AND RENTAL ARREARS OWED IN LIEU OF A CURRENT SIGNED LEASE
In accordance with the Coronavirus Aid, Relief, and Economic Security Act (“CARES Funding”)
received under Section 501(a) of Division N of the Consolidated Appropriations Act, 2021, Pub.
L. No. 116-260 (Dec. 27, 2020), the Landlord/Owner must provide a current lease, signed by the
Tenant and the landlord or sublessor that identifies the unit where the applicant resides and
establishes the rental payment amount. In lieu of a signed lease, the County must request another
form or documentation establishing residency.
In order to comply with Program guidelines, the Landlord/Owner/Property Manager must
complete one form, including the requested certifications, for each individual Tenant
Household/Rental Unit that is being claimed under the rental assistance application.
I/We , as the owner or property manager for rental unit
in the property located at , attest to the
following:
Tenant, , currently resides in the above-referenced rental
unit/single family home/condominium/other
Landlord/Owner/Property Manager entered into a lease agreement with the Tenant
beginning, , which expired on
Upon expiration of the Lease Agreement between Landlord/Owner/Property Manager
and Tenant, the Tenant was automatically converted to a month to month lease status
Tenant currently has an outstanding balance or rental arrears in the total amount of
$ , as evidenced in the submitted rental payment ledger
I certify under penalty of perjury that all of the information provided in this document is
complete and accurate to the best of my knowledge. I understand that Title 18, Section
1001 of
the U.S. Code states that a person is guilty of a felony and assistance can be terminated for
knowingly and
willingly making a false or fraudulent statement to a department of the United
States Government.
______________________________________ ______/______/2021
Signature: Owner/Landlord/Property Manager
______________________________________
Print Name: Owner/Landlord/Property Manager
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