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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 />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 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. I hereby attest that the <br />Impacted Tenants fisted below will be released from any remaining obligation for any rent arrears owed <br />(20%) following payment by the City of Santa Ana (8040). <br />The information below may be submitted in a separate spreadsheet attached to your application <br />Please include the minimum information below and name it Exhibit A - Property Name " <br />Property Name: <br />Property Address: <br />Tax ID for Payment: 3 3- a Ili' 3 2.Y <br />Full Name of Tenant <br />(as stated on the Lease) <br />Address of Tenant's Rental Unit <br />Total Amount <br />of Rent Arrears <br />Owed_ <br />r <br />�)l�r.i/✓ Capcx <br />/r/�2 5. a�ir/•vif 5? �3 <br />$ 0%0. <br />Gurl f�ve2 <br />$ <br />$ <br />$ <br />$ <br />$ <br />$ <br />$ <br />$ <br />Total Amount of Assistance <br />Requested <br />_ <br />$ /M <br />4Add additional pages it 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 Page 13 <br />Application <br />