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NJ DCF Logo with reverse copy

 

New Jersey Department of Children and Families Policy Manual

 

Manual:

CP&P

Child Protection and Permanency

Effective

Date:

Volume:

X

Forms

Chapter:

A

Forms

2-10-2003

Subchapter:

1

Forms

Issuance:

DOT.1

Department of Treasury Affidavit - Foster Parent Liability Program

 

Click here to view or print the Department of Treasury Affidavit.

 

PURPOSE AND USE

 

This form is used when a foster parent files a claim under the Foster Parent Liability Program for $350.00 or more and the foster parent has no homeowner’s (property liability) insurance.

 

INSTRUCTIONS FOR COMPLETING THE FORM

 

The foster parent completes the affidavit and returns the affidavit to the Local Office Foster Parent Liability Program Coordinator.

 

1.           Enter name and home address.

2.           Enter the date of the occurrence/incident for which the claim is being filed.

3.           Sign the affidavit in the presence of a notary public.

 

The notary public signs and dates the affidavit.

 

DISTRIBUTION

 

Original

-

Bureau of Risk Management

Copy

-

Foster Home Record