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Impacted Tenants List (Exhibit A) <br />this List will bacons E401ill A of Ilia rdnanl Aununrnonl Ilia/ you will anion Info with Itin City of Bantu Ano <br />Ilousahnlds with a Houxlnu Cltolco vouchor, shin known ON ,Socdlorr 0, or Ihnan who rncolvo other <br />uovonrmonl rental assistance are riot ollulblo I anarrle that you pion to evil,'/ Oro not allulbho Il la your <br />doclalun toinclude which tenants quollry on (film flat Plonso onsuro you have Q a slgnod copy of flra <br />I onao Aureornont vodlying nocupenay tot all lananlm on Ilia Impactor/ Tenants Lis( for whom you are <br />soaking usslslanco. 2) douumontollon on file for all tenants on fbo Impaclord Tenants List Had <br />duruonstreto Ilret Ilre tenant has boon Impaclorl by Coronavlrum and have lost/ohs, had their work hours <br />niducml, or /lava asperlanred a lose of Income due to Ilia oronotnlr, or health Impacts of Coronavbue and <br />who have boon unable to molndnln their real paynrsnte undor their loamo ogroomenls Insufficient or <br />rnlaeing dncunionfnllon may cause a delay hi prorossing nr, In some comes, a denial of Ilia application <br />Additional dorumnrunflon may he requested dudng Ilia review of your application I hereby offasl that Ilia <br />hnpnclud Tenants Iwod below will be relonsad front any ramalning obligation for any ronl orroors owed <br />(20%) hollowing payment by Ilia City of Santa Ana (I1096) <br />�IGeJrdatrnaUaaLa/atr.may111z.suU¢d(farLBi.aBaearafuapr>�rfafiattLellgatrarLlrzragLauWlanllam. <br />Planealnrlada.Via rnft&wminfaanaMLb&w grutlmma.Il Fxld�lfd_-1'iyvarlxNatn>t� <br />Property Name: SUw-4 -_fa-e (1r,0 <br />Property Address: r�aa_t_=+li _C1. .a1 a Park *f/3r 5am�& qNa 0A• <br />Tax ID for Payment: tt .I S s N <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 />W 1l l <br />eW <br />$ y <br />-------- <br />$ <br />- — <br />---_ <br />Total Amount of Assistance <br />Requested <br />$ i, S 0 s <br />nuu auununm puyus n nucussary. if you nave multiple properties and you are unable to <br />accept payment on behalf of nil of them, please list each property separately and provide the <br />name of the property at the lop of each list. <br />(&1'4--C�Qr3md 011000 {ril'i Nly u — rs/l0 Loss e#W <br />Coronavlrus Emergency Rental Relief Fund for Landlords Page 13 <br />Application <br />