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Impacted Tenants List (Exhibit A) <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 />declsion 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 rile for all tenants on the Impacted Tenants List that <br />demonstrate that the tenant has been Impacted by Coronavirus and have lost jobs, 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. insufficient or <br />missing documentation may cause a delay In processing or, in some cases, a denial of the application. <br />Additional documentation maybe requested during the review of your application, 1 hereby attest that the <br />Impacted Tenants listed below will be released from any remaining obligation for any rent arrears owed <br />(20%) following payment by the Clty of Santa Ana (80%). <br />Property Name: f C A-�t,Wp Q;'t,K. 1 ni(rrro d <br />Property Address: s la s- R A k ,++ S i � i <br />Tax ID for Payment: 3 3 — O.Z/ S, 'Z y <br />Full Name of Tenant <br />(as stated on the Lease) <br />_ <br />Address of Tenant's Rental Unit <br />Total Amount <br />of Rent Arrears <br />Owed <br />f7�hrcrA IiVfZ S / <br />_ <br />10 S <br />TLl4 ✓1 GT Vn CVS ^NuW P%,. <br />1• �^ <br />@$ <br />`P 7'/6 V• <br />$ <br />$ <br />$ <br />$ <br />$ <br />Total Amount of Assistance <br />Requested <br />$ <br />Add additional pages If necessary. If you have mdttiple properties and you are unable to <br />accept payment on behalf of aft 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 (3 <br />