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Impacted Tenants List (Exhibit ) _ _ <br />This List will become Exhibit A of the Grant Agreement that you will enter into with the City of Santa Ana. <br />Households with a Housing Choice Voucher, also known as Section 8, or those who receive other <br />government rental assistance are not eligible. Tenants that you plan to evict are not eligible. It is your <br />decision to Include which tenants qualify on this list. Please ensure you have: 1) a signed copy of the <br />Lease Agreement verifying occupancy for all tenants on the Impacted Tenants List for whom you are <br />seeking assistance; 2) documentation on file for all tenants on the Impacted Tenants List that } <br />demonstrate that the tenant has been impacted by Coronavirus and have lost jabs, had their work hours <br />reduced, or have experienced a loss of income due to the economic or health Impacts of Coronavirus and <br />who have been unable to maintain their rent payments under their lease agreements. Insuff e ptor <br />missing documentation may cause a delay in processing or, in some cases, a denial of the ap lication. <br />Additional documentation may be requested during the review of your application. I hereby at ast that the <br />Impacted Tenants listed below will be released from any remaining obligation for any rent arse rs owed <br />(20%) following payment by the City of Santa Ana (809/6), <br />Property Name: <br />Property Address: <br />Tax ID for Payment: <br />Full Name of Tenant <br />(as stated on the Lease) <br />Address of Tenant's Rental Unit <br />Total , mount <br />of Rent Arrears <br />Owed <br />Jose Rodriguez <br />809 West Stevens Ave Apt 7 <br />$ 41,990.00 <br />Reyna Hank <br />811 West Stevens Ave Apt 11 <br />$ )1,222.00 <br />George Saldivar <br />815 West Stevens Ave Apt 4 <br />$ 0,579.00 <br />Primitive Perez <br />819 West Stevens Ave Apt 16 <br />$ 6,237.80 <br />Eva Patina <br />831 West Stevens Ave Apt 1 <br />$ 4,075.00' <br />Timothy Squire <br />833 West Stevens Ave Apt 4 <br />$ 8,705.00 <br />Arlene Erickson <br />837 West Stevens Ave Apt 5 <br />$ f1,216.00 <br />Martha Plancarte <br />843 West Stevens Ave Apt 4 <br />$ 1,375.00 <br />$ l <br />$ <br />$ <br />$ i <br />$ <br />$ <br />Total Amount of Assistance <br />Requested <br />$ 23,399.80 <br />"Add additional pages if necessary. If you have multiple properties and you are unable to <br />accept payment on behalf of all of them, please list each property separately and provide the <br />name of the property at the top of each list. <br />Coronavirus Emergency Rental Relief Fund for Landlords <br />Application <br />Page 13 <br />