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Impacted Tenants List (Exhibit A) <br />This List wit become Exhibit A of ere Grant Agreement that you witf 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 rental assistance are not eFpble- Tenants that you plan to evict are not eligible. tt is your <br />decision to include which tenants quafdy on this fist Please ensure you have: 1) a signed copy of the <br />Lease Agreement verifying occupancy fora➢tenants on the Impacted Tenants List for whom you are <br />seeking assistance, 2) documentation on hie /oral, tenants on the impacted Tenants List that <br />demonstrate that the tenant has been impacted by Coronavims, and have tast jobs, had their work hours <br />reduced, or have experienced a loss of income due to the economic or heath impacts ofComnawnis and <br />who have been unable to maintain 8feirrent payments under their lease agreements Insutrrcient or <br />missing documentation may cause a delay m processing or, in some cases, a denial of the application <br />Additional documentation maybe requesteddining the review of yourapplicaimn. I hereby attest that the <br />Impacted Tenants listed below will be released from any remaining obligation forany rent arrears owed <br />(20%) m9owing payment by the City of Santa Ana (80%)- <br />"The information below may be sub milled in a separate slima dsheet aitach ed to your anpli anon <br />Please include the minimum information below and name it Exhibit A- Prop" Name- " <br />Property Name:ymage Woods <br />Property Address: 3900 w_ bin SL Santa Ann. CA 92703 <br />Tax ID for Payment: W1000587 <br />Pull Name of Tenant Total Amount <br />(as stated on the Lease) Address of Tenant's Rental Unit of Rent Arrears <br />Owed <br />Mafia Olivares, Lorenzo Arias, Joana Arias <br />3900 W. 5th St. #F-12 Santa Ana, CA 92703 <br />$ 4,790.00 <br />Normeli Moreno <br />3900 W. 5th St #K-15 Santa Ana, CA 92703 <br />$ 5,934.00 <br />Fmck Lino trios, Natalia Zegarra Saldl n <br />3900 W. 5th St. #Q-05 Santa Ana, CA 92703 <br />$ 1,015.00 <br />$ <br />$ <br />$ <br />$ <br />Total Amount of Assistance <br />Regclested $11,739.00 <br />