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Last modified
12/18/2020 1:50:46 PM
Creation date
12/18/2020 12:42:23 PM
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Template:
Contracts
Company Name
JULIET LE RANKIN
Contract #
A-2020-158-59
Agency
Community Development
Council Approval Date
8/4/2020
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Y <br />t 1 ''I li ;_ a <br />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 confirm that the <br />City's payment is necessary. Exhibit B of the template Agreement is the following documentation to <br />demonstrate that the landlord has experienced a loss of rent due to the Coronavirus during this same <br />period last year compared to this year. This information should include the entire property. If you have <br />multiple properties and you are unable to accept payment on behalf of all of them, please list each <br />property separately and provide the name of the property at the top of each list. <br />• Property Name: Village Walk Townehomes <br />• Property Address: 2911 S. Fairview St. Unit E Santa Ana, CA 92704 <br />• Tax ID for Payment: 547692986 <br />• Total rent payments received between January 1, 2019 to June 30, 2019: <br />$13, 800.00 <br />Total rent payments received between January 1, 2020 to June 30, 2020: 6105 <br />• Difference in Revenue / Rent between 2019 to 2020 (Subtract 2020 from 2019): - 7695 = <br />Revenue Loss or Rent Loss due to the Coronavirus <br />This program is supported with Federal funding. According to Title 18, Section 1001 of the U.S. <br />Code, it is a felony for any person to knowingly and willingly make false or fraudulent statement <br />to any department of the United States Government. By providing my signature below, i certify <br />under penalty of perjury, that all the information on this application is correct to the best of my <br />knowledge and belief, and I acknowledge that such information Is subject to verification. 1 also <br />acknowledge that my failure to provide necessary documents within a reasonable period of time <br />or falsification of this Information shall be grounds for my denial of assistance, and that I may be <br />subject to prosecution under the law. I authorize the release of said information to local, State <br />and/or Federal agencies and to City Santa Ana staff within five years of this date. <br />Landlord Name (Print): Juliet Le Rankin Date: Dec. 1, 2020 <br />Landlord Signature: �aFurZe Ra.dxa Date: Dec. 1, 2020 <br />Coronavirus Emergency Rental Relief Fund for Landlords Page 14 <br />Application <br />
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