04/16/1996BAYSHORE MANOR
A/K/A/ MONROE COUNTY HOME
ASSISTED LIVING FACILITY
FOR THE ELDERLY
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THIS AMENDMENT to AGREEMENT entered into thisday of Q ! L ,19�, by and
between the County of Monroe, Florida, hereinafter called "COUNTY" and
CARMsUA 6-. CyT I , hereinafter called "RESIDENT" and A u TA W 40►EP. ,
hereinafter called "RESPONSIBLE PARTY".
WHEREAS COUNTY, RESIDENT and RESPONSIBLE PARTY did enter into an
AGREEMENT dated AIA11 c. H J � , J t % , and
WHEREAS, COUNTY, RESIDENT and RESPONSIBLE PARTY agree that RESIDENT and
not RESPONSIBLE PARTY has sole financial responsibility for paying COUNTY $1850.00
per month for use of COUNTY'S Bayshore Manor facility under the terms of the
AGREEMENT; and
WHEREAS, RESIDENT'S monthly income consists of a Social Security payment of $864.00
and a payment of $986.00 from Putnam U.S. Government income trust fund; and
WHEREAS, COUNTY recognizes that if and when RESIDENT no longer receives sufficient
income necessary to continue paying to COUNTY, on a monthly basis, the dollar amount
required in the AGREEMENT, COUNTY should accept, on a monthly basis, such income
received by her on a monthly basis as payment in full for her continued residency at Bayshore
Manor,
NOW, THEREFORE, the Parties agree as follows:
1. PARAGRAPH C of the AGREEMENT be amended to state that monthly payments are
derived from a combination of a monthly Social Security income of $864.00 and a Putnam U.S.
Government income trust income of $986.00 and payment is sole responsibility of RESIDENT.
2. If and when RESIDENT no longer has sufficient monies necessary to continue paying to
COUNTY, on a monthly basis, the dollar amount requires by the AGREEMENT, County will
accept, as payment in full each month all monies received by her on a monthly basis from the
Social Security Administration and any other source of income.
3. That RESPONSIBLE PARTY shall have no obligation to supplement RESIDENT'S income
to meet the monthly payment for residency at Bayshore Manor.
The Parties further agree that in all other respects, the AGREEMENT between them dated the
JLday of )NARC rl , 19 1remains in full force and effect.
IN WITNESS WHEREOF, the Parties have hereunder set their hands and seals, the day and year
first above written,
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�IG ATURE OF RESIDENT
1
SI ATURE OF RE PONSIBLE PARTY
WITNESS AS TO RESIDENT AND
RESPONSIBLE PARTY
DATE:
SIG R
BAYSHORE MA O
DATE:
SIGNATURE OF EXEC. DIRECTOR
SOCIAL SERVICES D ARTMENT
DATE:
SIGNATURE OF COUNTY ADMINISTRATOR