Ch. 207

2003 LAWS OF MARYLAND

(I)      THE NAME AND DATE OF BIRTH OF THE CHILD;

(II)     THE NAME AND ADDRESS OF THE CHILD'S PARENT OR LEGAL
GUARDIAN;

(III)   THE NAME AND ADDRESS OF THE RELATIVE PROVIDING
INFORMAL KINSHIP CARE;

(IV)    THE DATE THE RELATIVE ASSUMED INFORMAL KINSHIP CARE;

(V)     THE NATURE OF THE SERIOUS FAMILY HARDSHIP AND WHY IT
RESULTED IN INFORMAL KINSHIP CARE;

(VI)    THE KINSHIP RELATION TO THE CHILD OF THE RELATIVE
PROVIDING INFORMAL KINSHIP CARE;

(VII)  THE NAME AND ADDRESS OF THE SCHOOL THE CHILD
PREVIOUSLY ATTENDED;

(VIII) NOTICE THAT THE COUNTY SUPERINTENDENT MAY VERIFY
THE FACTS GIVEN BY THE RELATIVE PROVIDING INFORMAL KINSHIP CARE IN THE
AFFIDAVIT AND CONDUCT AN AUDIT OF THE CASE AFTER THE CHILD HAS BEEN
ENROLLED IN THE COUNTY PUBLIC SCHOOL SYSTEM;

(IX) NOTICE THAT IF FRAUD OR MISREPRESENTATION IS
DISCOVERED DURING AN AUDIT, THE COUNTY SUPERINTENDENT SHALL REMOVE
THE CHILD FROM THE COUNTY PUBLIC SCHOOL SYSTEM ROLL; AND

(X) NOTICE THAT ANY PERSON WHO WILLFULLY MAKES A
MATERIAL MISREPRESENTATION IN THE AFFIDAVIT SHALL BE SUBJECT TO A
PENALTY PAYABLE TO THE COUNTY FOR THREE TIMES THE PRO RATA SHARE OF
TUITION FOR THE TIME THE CHILD FRAUDULENTLY ATTENDS A PUBLIC SCHOOL IN
THE COUNTY.

(4) THE AFFIDAVIT SHALL BE IN THE FOLLOWING FORM:

(I)      I, THE UNDERSIGNED, AM OVER EIGHTEEN (18) YEARS OF AGE
AND COMPETENT TO TESTIFY TO THE FACTS AND MATTERS SET FORTH HEREIN.

(II) _______.           (NAME OF CHILD), WHOSE DATE OF BIRTH IS

___________, IS LIVING WITH ME BECAUSE OF THE FOLLOWING SERIOUS FAMILY

HARDSHIP: (CHECK EACH THAT IS APPLICABLE)

____DEATH OF FATHER/MOTHER/LEGAL GUARDIAN

____SERIOUS ILLNESS OF FATHER/MOTHER/LEGAL GUARDIAN

____DRUG ADDICTION OF FATHER/MOTHER/LEGAL GUARDIAN

____INCARCERATION OF FATHER/MOTHER/LEGAL GUARDIAN
____ABANDONMENT BY FATHER/MOTHER/LEGAL GUARDIAN

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