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Certification of Loss of Rent due to the Coronavirus (Exhibit B) <br />The City is required to verify your revenue loss or rent loss due to the Coronavirus to <br />confirm that the City's payment is necessary. Exhibit 6 of the template Agreement is <br />the following documentation to demonstrate that the landlord has experienced a loss of <br />rent due to the Coronavirus during this same period last year compared to this year. <br />This information should include the entire property. If you have multiple properties and <br />You are unable to accept payment on behalf of all of them, please list each property <br />separately and provide the name of the property at the top of each list. <br />• Property Name: <br />• Property Address: <br />• Tax ID for Payment: <br />Advancud Property Sorvices Manayomenl, Inc. <br />14211 Ye, ba Strcel 0200, 1 mil11, CA 92700 <br />36-44878115 <br />• Total rent payments received between January 1, 2019 to June 30, 2019: <br />$ 4,556„I90.86 <br />• Total rent payments received between January 1, 2020 to June 30, 2020, <br />;� asal,r,9n.7o <br />• Difference in Revenue / Rent between 2019 to 2020 (Subtract 2020 from 2019): <br />Revenue Loss or Rent Loss due to the Coronavirus <br />This program is supported with Federal funding. According to Title 18, Section <br />1001 of the U.S. Code, it is a felony for any person to knowingly and willingly <br />make false or fraudulent statement to any department of the United States <br />Government. By providing my signature below, I certify under penalty of perjury, <br />that all the information on this application is correct to the best of my knowledge <br />and belief, and I acknowledge that such information is subject to verification. I <br />also acknowledge that my failure to provide necessary documents within a <br />reasonable period of time or falsification of this information shall be grounds for <br />my denial of assistance, and that I may be subject to prosecution under the law. I <br />authorize the release of said information to local, State and/or Federal agencies <br />and to City Santa Ana staff within five years of this date. <br />Landlord Name (Print): 13a ottIc _ Date:.0812012020 <br />Landlord Signature: —__ — — Date: ocorzozo <br />Vlra, f, fill u1�'nt �� , m I _ -- -— <br />iIm ni Ire f_u' I U rc y.� I � fh � i � ,x;it-1 u17�' 19. 11 I i due Ic JU 19 iCnt <br />III rr.I ,�hu II v, I I.i roc 4 I >1J "un t 1iwi. iikl ,IV a ,r 2020 u11u>frd <br />schednl d „ri7•e� ru d,51, '; IR-)i1 r. ,dlui;� in a ni li,Iss o $39.9�.L.16. Ili nrldikfnl Ow "VII) If) e>; r•cutiee <br />ordo, did TIO 1A;o l I un[ii �,r�tl irl ":Id it;,n h my r„ v'f(I flue, of„,n PA to 1, )070 rt uh. lilarr,fow, Oil <br />inlpafwd prriod Is a 'tl?o hI wu�;Il is 'l,Z ;. <br />c,oronavlrus t mergency Rental Relief Fund for Landlords page 14 <br />Application <br />