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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: t) 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 may be requested during the review of your application. I 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 />" 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: TI-F19 Pc12-ftrZ-b/t^ L1tFl! W INVGSTM0417S <br />Property Address: I I w - l-4m E F-A aJsNV6N swrn- NN rL <br />Tax ID for Payment: 5rv'6 - 50 -2-0 939 <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 />UN I- e A <br />1100 F:!Ai►2NAVCN 4�r <br />$ <br />tit X�Ll of Og <br />11.M 1►ek4A VrWN+� ( <br />$ bU <br />WroNii) 01 30 <br />1=A i a4orycN ry 1 <br />$ L4 1 DO <br />l,0 E12 <br />FAlVLAAVC-&J-W 2 <br />$ D <br />l7 NItt.Li: SEtP-,>rt- <br />IZoo r^irc- kK—f-4 *1 <br />$ 10 30 <br />El2N hWDD Ng- LLM <br />1 'r-A I l2#AVVtJ 41 b S <br />$ Le WAr::o <br />AAAM COO H <br />l ►J 13i- <br />$ 10, a(O <br />$ <br />$ <br />$ <br />$ <br />$ <br />$ <br />$ <br />Total Amount of Assistance <br />Requested <br />$ <br />"Add additional pages if 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 <br />Application <br />Page 13 <br />