Ch. 206                                    2003 LAWS OF MARYLAND

(3) THE NAME AND LAST KNOWN ADDRESS OF THE CHILD'S PARENT(S)
OR LEGAL GUARDIAN IS:

(4)      MY KINSHIP RELATION TO THE CHILD IS__________

(5)      MY ADDRESS IS:

STREET                            APT. NO.

CITY             STATE             ZIP CODE

(6)      I ASSUMED INFORMAL KINSHIP CARE OF THIS CHILD FOR 24 HOURS
A DAY AND 7 DAYS A WEEK ON_______________(DAY/MONTH/YEAR).

(7)     THE NAME AND ADDRESS OF THE SCHOOL THAT THE CHILD
ATTENDS IS:

(8) I SOLEMNLY AFFIRM UNDER THE PENALTIES OF PERJURY THAT THE
CONTENTS OF THE FOREGOING ARE TRUE TO THE BEST OF MY KNOWLEDGE,
INFORMATION, AND BELIEF.

SIGNATURE OF AFFIANT

(DAY/MONTH/YEAR)

(E)     AFFIDAVIT FORMS THAT COMPLY WITH SUBSECTION (D) OF THIS SECTION
SHALL BE MADE AVAILABLE FREE OF CHARGE AT THE OFFICES OF EACH COUNTY
BOARD OF EDUCATION AND EACH LOCAL HEALTH DEPARTMENT.

(F)     IF A CHANGE OCCURS IN THE CARE OR IN THE SERIOUS FAMILY
HARDSHIP OF THE CHILD, THE RELATIVE PROVIDING INFORMAL KINSHIP CARE
SHALL NOTIFY THE LOCAL DEPARTMENT OF SOCIAL SERVICES DEPARTMENT OF
HUMAN RESOURCES, SOCIAL SERVICES ADMINISTRATION IN WRITING WITHIN 30
DAYS AFTER THE CHANGE OCCURS.

(G)     THE RELATIVE PROVIDING INFORMAL KINSHIP CARE SHALL FILE AN
AFFIDAVIT ANNUALLY WITH THE LOCAL DEPARTMENT OF SOCIAL SERVICES

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