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Impacted Tenants List (Exhibit A) This List will become Exhibit A of the Grant Agreement that you will enter into with the City of Santa Ana, Households with a Housing Choice Voucher, also known as Section 8, or those who receive other government rental assistance are not eligible. Tenants that you plan to evict are not eligible, It is your decision to include which tenants qualify on this list. Please ensure you have: 1) a signed copy of the Lease Agreement verifying occupancy for a/f tenants on the impacted Tenants List for whom you are seeking assistance, 2) documentation on file for all tenants on the Impacted Tenants List that demonstrate that the tenant has been impacted by Coronavirus and have lost jobs; had their work hours reduced, or have experienced a loss of income due to the economic or health impacts of Coronavirus and who have been unable to maintain their rent payments under their lease agreements. Insufficient or missing documentation may cause a delay "in processing or, In some cases, a denial of the application. Additional documentation maybe requested during the review of your application. i hereby attest that the Impacted Tenants listed below will be released from any remaining obligation for any rent arrears owed (20916) following payment by the City of Santa Ana (80%). M Property Blame: village apts Property Address: 563 n, tustin avenue santa ana, ca 92705 Tax ID for Payment: 565-64-4471 Full Name of Tenant (as stated on the Lease) Address of Tenant's Rental Unit Total Amount of Rent Arrears Owed brittan n. piha 563 n. tustin ave #d santa ana, ca 92705 $ 7,550 $ $ Total Amount of Assistance Requested $ 7,550 *Add additional pages if necessary. If you have multiple properties and you are unable to accept payment on behalf of all of them, please list each property separately and provide the name of the property at the top of each list. Coronavirus Emergency Rental Relief Fund for Landlords Page 13 Application