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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 Ann. - <br />Households with a Housing Choice Voucher, also known as Section B. or those who receive other <br />government rental essistancu are nor eligible. Tunanls that you plan to evict are liar eligible, ft is your <br />decision to include which tenants qualify on this list. Please unsure you have: 1) a signed copy of the <br />Lease Agruument verifying occupancy for all tenants on the Impacted Tenants List for Whom you are <br />seeking assistance: 2) documentation on file for oil tenants oe the Impacted Tenants List that <br />demonstrate that rho lament has been impacted by Coronavirus and have losijobs, had their work hour, <br />reduced, or have experienced a loss or 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 or the application. <br />Additional documentation may be requested during the review Ol your application. 1 heraby allost that the <br />Impacted Tenants listed below will be released from any remaining obligation for any rent Smears owed <br />(205n) following payment by the City of Santa Ana (8055)- <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: <br />Property Address: 0 / J. �r Sa ar <br />Tax ID for Payment: <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 />nrdo 0na _ <br />4/ S G t #y4' <br />$ Oa 7J <br />S fi� <br />5 <br />S <br />S <br />S <br />8 <br />b <br />5 <br />S <br />S <br />S <br />S <br />Total Amount of Assistance <br />Reg_uested <br />$ ,� D <br />r <br />-Add aaomonar pages it necessary. it you have multiple pmperiies and you are unable to <br />accept payment on behalf of alf or therm, please fist e.a, h pr:rpertq separately and provide the <br />name of the property at the fop of each fist. <br />Coronavirus Emergency Rental Relief Furst; fc-r Land'unJs Page 13 <br />