Laserfiche WebLink
Cevltficertlon of loss of Ranf slue to the Cotonsvinig Exhibit Of <br />The Oily it retiulred to verify your revenue tons or rent lass dug to the Coronavirus to <br />confirm that the C:ity's poymeni Is necesssry. Exhibit a of IN template Agreement is <br />the following documentation to domonstrate that The landlord has experienced a loss of <br />rent due to the Corollavirus during this %ame period last year compared to this year. <br />This Information should include the entire property, if you have multiple propedles 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 top of each Ifst <br />• Property Name: ^'�rrr»cn <br />• Property Address. .�DIQ cry cr-arq �!3�. eqr,,a Flno, <br />• Tax ID for Payment: <br />• Totai resit payment received between January 1, 2019 to June 30, 2019: <br />�J. J <br />Total rent payments received between January 1, 2020 to June 30, 2020. <br />245. (-Z. <br />i_ • Difference in Revenue ! Rent between 2019 to 2020 (Subtract 2020 from 2019): <br />Qts, A/c) h- - * ($ i 3, — Revenue Loss or Resit toss due to the Coronavirus <br />This program Is supported with Federal funding. According to Title 18, Section <br />1001 of tile 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 knnowledge <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 t may be subject to prosecution under the law. t <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): Data. ^ t o-2a'=zvOC <br />Landlord Stonature. : LvinxD*W r'0 -2,?- ZVZO <br />A/o- 7�idrrt c�r�5 na�ct has v�rxr� r�ihevr c�r»�acr,nr <br />2OL.0 fn 2OJ �%, fa2C � cr�e »ri � rncr ect�e � c ✓q � g ,��trzd <br />t'ur�nc zwq &Ar' k) r-r)r,5zc,/ Fire Gtnfi'c�`/6ct �-ej 1 <br />fh2 <5'�t� cod" Erg-,xr��hec� e�+c% eno-� :3�.--�- t✓�h / Nc�r-e6r Zu�d, <br />coronavirus Emergency Rental Relief Fund for'Landfords page l q <br />Application <br />