Affidavit of Separation

I, __________________________________, hereby certify that I am separated

and estranged from my spouse (enter name of spouse)____________________________.

I further certify that I do not intend to reconcile with my spouse. However, if

such reconciliation occurs, my spouse will not be permitted to reside in __________

__________________________ unless at least twelve months have elapsed since the

(Name of Property)
beginning of the initial lease term.

If reconciliation occurs prior to the expiration of the twelve month timeframe

cited above, and my spouse wishes to reside in _______________________________,

our entire household must requalify as a new household.

______________________________
Applicant

______________________________
Date