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Impacted Tenants List (Exhibit A <br />This List wilt 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 a, or those who receive other <br />government rental assistance are not eligible. Tenants that you plan to evict are not efigible. It is your <br />decision to include which tenants qualffy 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 wham 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 lostjobs, 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. insuftlent 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, f 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 City of Santa Ana (80%). <br />Property Name: rGii r vl'e�c # f� <br />Property Address: 284 5 F0.i rvi et S ..rR Cc412t �tza CJf `70 <br />Tax ID for Payment. (vIS - f-v <br />Fa <br />Full Name of TLease) enant Total �Amount <br />Address of Tenant's Rental Unit of Rents stated on theArrears <br />GO() <br />Is Add additional pages tf necessary, If you have multiple proportres 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 Emergenry Rental Relief Fund for Landlord; <br />Application Page 3 <br />