My WebLink
|
Help
|
About
|
Sign Out
Home
Browse
Search
BRIAN PHAM
Clerk
>
Contracts / Agreements
>
B
>
BRIAN PHAM
Metadata
Thumbnails
Annotations
Entry Properties
Last modified
12/1/2020 4:36:11 PM
Creation date
12/1/2020 4:35:24 PM
Metadata
Fields
Template:
Contracts
Company Name
BRIAN PHAM
Contract #
A-2020-158-46
Agency
Community Development
Council Approval Date
8/4/2020
There are no annotations on this page.
Document management portal powered by Laserfiche WebLink 9 © 1998-2015
Laserfiche.
All rights reserved.
/
19
PDF
Print
Pages to print
Enter page numbers and/or page ranges separated by commas. For example, 1,3,5-12.
After downloading, print the document using a PDF reader (e.g. Adobe Reader).
View images
View plain text
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 B 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 tap of each list. <br />• Property Name: Feii iry rew #' /4 <br />• Property Address: H ? e: i rvrcul 8 Aff I Sao 1 k 0,.,a , 0 q 2 70Y <br />• Tax ID for Payment: <br />• Total rent payments received between January 1, 2019 to June 30, 2019: <br />$ LiLe O(o <br />• Total rent payments received between January 1, 2020 to June 30, 2020. <br />i2, Goo — <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. <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): 13rlb, Vi PhCLWI <br />Date: it Z 9 '2 o <br />Landlord Signature: Date: i o <br />Coronavirus Emergency Rental <br />Application <br />Fund for <br />Page 14 <br />
The URL can be used to link to this page
Your browser does not support the video tag.