Dear Medi-Cal Access Program,. I am providing this affidavit to verify my income as I have no other income documentation available to me.CitizenPath has prepared a downloadable I751 affidavit sample that you can forward to friends who are willing to write a letter of support. Thus, you must complete all areas of this affidavit that apply, including original signatures. I certify that the information I have provided is accurate and complete to the best of my knowledge. A Caregiver's Authorization Affidavit is an official form based on California's recognition that adults who have minors living with them are "caregivers." On this page are descriptions of the various forms that landlords might encounter when participating in the HCV program. The affiant should be honest and use anecdotes to demonstrate why they came to the conclusion that the couple has a bona fide marriage.