Tenant COVID-19 Hardship Declaration & Affidavit

Please fill out this form if you are a current OakCLT tenant and are seeking financial support as a result of a COVID-19 related hardship.









Names of all other household members


I declare, under penalties of perjury, as follows:
1. I pay rent to:
whose contact information is:







2. My household has lost significant income due to COVID-19 and is now unable to pay rent or other financial obligations under our lease because of one or more of the following reasons.
  • Loss of income caused by the COVID-19 pandemic. 
  • Increased out-of-pocket expenses directly related to performing essential work during the COVID-19 pandemic. 
  • Increased expenses directly related to health impacts of the COVID-19 pandemic.
  • 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. 
  • Increased costs for childcare or attending to an elderly, disabled, or sick family member directly related to the COVID-19 pandemic. 
  • 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. 


5. My household does not have sufficient savings or liquid assets to pay the rent.
I hereby swear and affirm under penalty of perjury that the above information is true and correct to the best of my knowledge and belief. 

I am signing this Declaration and Affidavit by electronically entering my name below .



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