To WHOM IT MAY CONCERN: Public housing at authorities are required by Federal not verify any child care for paid by the residence so that the cost me be taken into consideration when rent is is computed into the family. You will note that the head of household has signed a release below, giving you permission to provide us with the information. If you could fill out the form below and return it in the self addressed stamped envelope, at you earliest convenience it would be most appreciated.
sincerely yours

I hereby certify that I provided care (first names of children cared for) for

whom reside in the household of (personal signing the release below.)

Weeks of year
Per hour

Care during the week will be offered as follows


hereby authorize the release of the requested information