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OLD COMPOSITION (MEMBERS OF YOUR FAMILY WHO LIVE WITH YOU) YOU MUST HAVE THIS FORM FILLED OUT. IF YOU ARE A PAYEE FOR A CHILD ON TEMPORARY ASSISTANCE, OR IF YOU ARE RELATED TO THE PERSON WHO PAYS YOU RENT, OR IF YOU ARE A HOME OWNER, YOU MUST ALSO USE SECTION II. SECTION I VERIFICATION OF RENT MUST BE COMPLETED IN FULL ONLY BY LANDLORD (OWNER OF RECORD) OR AUTHORIZED REPRESENTATIVE. I HEREBY VERIFY THAT I OWN AND I AM RENTING THE PREMISES AT: TO: (WHO PAYS THE RENT?) EXACT STREET ADDRESS CIT.

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