1. I First Name* Last Name* have disclosed all previously received funding through the grants listed below. I also affirm to the fact that I have not received any other type of funding to help assist me with the services I am applying for.
2. I make this affidavit in connection with services that I am applying for through this nonprofit which has been funded by the City of Irving's Coronavirus Aid, Relief, and Economic, Security Act of 2020 (CARES Act).
3.The Recipient has received or it is reasonably anticipated that the Recipient will received the following Federal assistance funding to prevent, prepare for, or respond to the Coronavirus/COVID-19 pandemic (check all that apply AND include amount):
4. The Recipient has not received, or is reasonably anticipated that the Recipient will receive, any othe Federal assistance funds to orevent, prepare for, or respond to, the Coronavirus/COVID-19 pandemic other than that set forth above.
5. The Recipient can produce documentation for loss/expenses incurred related to the Coronaviru/COVID-19 pandemic.
6. The Recipient understands that, should the US Department of Housing and Urban Development (HUD) or the City of Irving determine that the Recipient has received a duplication of benefits, the Recipient may be required to repay a portion or all of the assistance provided by HUD and/or City or Irving
Signature:Signature* Client Name:First Name* Last Name* Current Address of Residence:Street Address* Address Line 2* City* State* Postal/Zip Code* Phone Number:Phone Number of Recipient *