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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 Cifyot'santa Ana. <br />Households with a Housing Choice Voucher; also known as Section 6, or those who receive other <br />government rental assistance are not eligible. Tenants thatyou plan to evict are not eligible. Itisyour <br />decision to Include which tenants qualify on this Ift Please ensure you have: 1) a signed copy ofthe <br />Lease Agreement verifying occupancy for all tenants on the Impacted Tenants List for whom you are <br />seeking assistance; 2) documentation On file forall tenants on the Impacted Tenants List that <br />demonstrate that the tenanthas boon Impacted by Coronavirus, and have lostjobs, had theirwork hours <br />reduced, or have wrilorienced a loss of income duo to the economic OF health of 0 rovi n <br />-to maintain thoiriontpayments under agreements. Insufficient or <br />who have been unable Impacts C na rus and <br />missing docutrentation may cause a dolayin processing or, In some cases, a denlel'of-the application. <br />Additional documontatlon maybe 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 />Property Name: CA <br />Property Address: n ) <br />A <br />Tax 11) for Payment: <br />Full Name of Tenant <br />(.as stated on the Lep!.je) <br />Address of Tenant's Rental Unit <br />Total Amount <br />of Rent Arrears; <br />BmAji 3ohn5Or-1 <br />e, <br />0 raM Ave <br />--Owed <br />$ �, Wis, no <br />A—LMS �, <br />Total Amourit of Assistance <br />Pe nested <br />$ 6d'I a,, A <br />1-1111, ­111-11a, vavuo 11 llu­o"'Y- 11 You "Elve multiple properties and you are unable to <br />accept payment on behalf of all of them, Please Ifint each properly separately and provide the <br />name of the properly at the top of each list. <br />Coronavirus Emergency Rental Relief Fund for Landlords Page 13 <br />Application <br />