VAWA Legal Document for RD TYSK

VAWA Legal Document for RD TYSK

This VAWA Declaration and Certification for RD TYSK (the Agreement) is entered into on by and between Owner/Agent Name: and Tenant/Applicant Name: concerning the property identified as RD TYSK located at .

RECITALS

WHEREAS, Owner/Agent administers or owns residential premises that are subject to federal rural housing program requirements identified in RD TYSK and provides certain tenant protections under the Violence Against Women Act (VAWA) in applicable circumstances; and

WHEREAS, Tenant/Applicant asserts that Tenant/Applicant is a covered individual as defined below and seeks the protections and remedies available under VAWA in connection with occupancy, termination, or transfer of tenancy; and

WHEREAS, Owner/Agent and Tenant/Applicant wish to set forth procedures for certification, confidentiality, notice, and remedial measures to be applied to claims invoking VAWA protections for the RD TYSK property.

NOW, THEREFORE, in consideration of the mutual covenants contained herein and other good and valuable consideration, the parties agree as follows.

1. DEFINITIONS

1.1 "Covered Individual" means Tenant/Applicant or an affiliated household member who meets the statutory definition of a person eligible for protection under VAWA due to being a victim of domestic violence, dating violence, sexual assault, or stalking.

1.2 "Confidential Information" means any documentation, statements, or records provided by a Covered Individual in support of a VAWA claim, including but not limited to affidavits, police reports, protective orders, and medical or social services records.

2. CERTIFICATION OF ELIGIBILITY

Tenant/Applicant hereby certifies under penalty of perjury that Tenant/Applicant is a Covered Individual by reason of one or more of the following incidents (check all that apply and provide a narrative description below):

Domestic violence    Dating violence    Sexual assault    Stalking

Tenant/Applicant attests that the information and documentation submitted in support of this certification are true and accurate to the best of Tenant/Applicant's knowledge and that false or materially misleading statements may subject the certifying individual to civil or criminal penalties to the extent permitted by law.

3. REQUESTED RELIEF

Tenant/Applicant requests the following remedies and relief under VAWA (check all that apply):

Termination of tenancy without penalty due to VAWA-covered incident
Emergency or requested transfer to alternative housing
Reasonable accommodation or modification to keep the household safe
Other (describe below)

Requested effective date for relief:

4. SUPPORTING DOCUMENTATION

Tenant/Applicant submits or will submit one or more of the following documents to substantiate the claim (check boxes to indicate provided or to be provided):

Police report or incident report
Protective order or restraining order
Affidavit from qualified third party (e.g., health professional, advocate)
Medical or counseling records
Other documentary evidence (describe below)

5. OWNER/AGENT OBLIGATIONS

Owner/Agent agrees to treat all Confidential Information as protected and to disclose such information only as permitted by law or when necessary for delivering the relief requested by Tenant/Applicant. Owner/Agent shall not use a Tenant/Applicant's status as a Covered Individual as an independent basis for adverse housing action, including eviction, denial of renewal, or refusal to re-rent, except where an Owner/Agent can demonstrate a bona fide safety concern that cannot be mitigated by reasonable accommodation.

Owner/Agent shall provide Tenant/Applicant with written notice of any adverse action that materially affects tenancy and shall state the factual basis for that action. Owner/Agent will allow Tenant/Applicant a reasonable opportunity to cure any non-VAWA-related lease violations in accordance with applicable program rules and governing law, unless immediate action is required to address a material and imminent threat to other residents.

6. CONFIDENTIALITY & RELEASE

Tenant/Applicant authorizes Owner/Agent to verify submitted documentation and to disclose only the minimum necessary Confidential Information to those persons or entities directly involved in determining eligibility for VAWA protections or in implementing the requested relief. Tenant/Applicant may withdraw this authorization in writing; however, withdrawal may affect Owner/Agent's ability to provide requested relief.

Tenant/Applicant consents to limited disclosure of Confidential Information to relevant program administrators, housing providers, and legal counsel solely for the purpose of processing this VAWA request, resolving disputes related to the request, or protecting the safety of the household, provided such disclosure complies with applicable privacy obligations.

7. NOTICES

Notices delivered in accordance with the addresses provided above shall be effective upon receipt as established by common delivery standards, and each party agrees to provide updated contact information promptly if addresses change.

8. REMEDIES, ENFORCEMENT AND LIMITATIONS

The parties acknowledge that remedies for violations of VAWA protections may include injunction, specific performance, damages where permitted by law, and administrative sanctions. Nothing in this Agreement shall limit Owner/Agent's right to pursue remedies for lease violations unrelated to VAWA-covered incidents, provided such actions comply with the protections afforded by VAWA and applicable law.

9. AMENDMENTS; WAIVER; COUNTERPARTS

This Agreement may be amended only by a written instrument signed by both parties. No waiver of any provision shall be effective unless in writing and signed by the party granting the waiver. This Agreement may be executed in counterparts, each of which shall be deemed an original and all of which together shall constitute one and the same instrument.

10. GOVERNING LAW; SEVERABILITY; ENTIRE AGREEMENT

This Agreement shall be governed by and construed in accordance with the laws of the State of , without regard to conflict of laws principles.

If any provision of this Agreement is held invalid or unenforceable by a court of competent jurisdiction, the remaining provisions shall remain in full force and effect. This Agreement constitutes the entire agreement between the parties with respect to the subject matter hereof and supersedes all prior understandings and agreements, whether written or oral.

11. CERTIFICATION

By signing below, each party certifies that they are authorized to execute this Agreement, that the statements and documentation supplied in connection with any VAWA claim are true and accurate to the best of their knowledge, and that they understand that knowingly submitting false information may subject the submitting party to penalties under applicable law.

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