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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 rentel 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 ail 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 duo 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 Fittest that the <br />impacted Tenants listed below will be released from any remaining obligation for any rent arrears owed <br />(20%) followfng payment by the City of Santa Ana (80%), <br />*M <br />Property Name: Tde?hn ltei l lrlbar-�rrt vn <br />Z <br />Property Address: aio�;2deys l �/ 71� 191)ca, (YA - 92-706- <br />Tax ID for Payment 20 - 7e 3; <br />Full Name of Tenant <br />(as stated on the Lease) <br />_ <br />Address of Tenant's Rental Unit <br />arrtr� 19y» c?A_ 9os <br />Total Amount <br />of Rent Arrears <br />Owed <br />$ <br />........... _.... _ <br />Total Amount of Assistance <br />Requested <br />$ 151200 <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 fist <br />Coronavirus Emergency Rental Relief Fund for Landlords page g <br />Application <br />