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DECLARATION OF COVID-19-RELATED FINANCIAL DISTRESS

State law provides eviction protections through January 31, 2025, but in order to be protected you must (1) Return the declaration of COVID-19-related financial distress hardship declaration within 15 days after receiving any eviction notice, and (2) Pay 25 percent of all rent owed for September 1, 2020 through January 31, 2021 by January 31, 2021.

Declaration of COVID-19-related financial distress”means the following written statement:
I am currently unable to pay my rent or other financial obligations under the lease in full because of one or more of the following:

1. Loss of income caused by the COVID-19 pandemic.

2. Increased out-of -pocket expenses directly related to performing essential work during the COVID-19 pandemic.

3. Increased expenses directly related to health impacts of the COVID-19 pandemic.

4. Childcare responsibilities or responsibilities to care for an elderly, disabled, or sick family member directly related to the
COVID-19 pandemic that limit my ability to earn income.

5. Increased costs for childcare or attending to an elderly, disabled, or sick family member directly related to the COVID-19 pandemic.

6. Other circumstances related to the COVID-19 pandemic that have reduced my income or increased my expenses. Any public assistance, including unemployment insurance, pandemic unemployment assistance, state disability insurance (SDI), or paid family leave, that I have received since the start of the COVID-19 pandemic does not fully make up for my loss of income and/or increased expenses.

Dated:_____________________
Signed under penalty of perjury: ________________________________________________