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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 Ana. <br />Households with a Housing Choice Voucher, also known as Section 8, or those who receive other <br />government rental assistance are not eligible. Tenants that you plan to evict are not eligible. It is your <br />decision to include which tenants qualify on this list. Please ensure you have: f) a signed copy of the <br />Lease Agreement verifying occupancy for all tenants on the Impacted Tenants List for whom you are <br />seeking assistance; 2) documentation on rile for all tenants on the Impacted Tenants List that <br />demonstrate that the tenant has been impacted by Coronavirus and have lost jobs, had their work hours <br />reduced, or have experienced a loss of 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 of the application. <br />Additional documentation may be 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 />(20916) following payment by the City of Santa Ana (809/6). <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: R afkMgYV S <br />Property Address: 1100 t4o SVOY Scarrta Ahal CA <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 />S' a -IfAbAta <br />1100 No s or < vw,,Ch <br />$ cIS <br />LIN <br />1900 go s ! 100. CA <br />$ 3-1 <br />p < <br />TOFUA #\S xx+ hP4CA <br />$ 3 3$CO <br />T158-ulod n� n a <br />-t jOqS C <br />$ 2 460 <br />100 N rep SankA PewmG <br />$ <br />uTCerrev <br />(90o No S r o F1 A c <br />$ 4 11S <br />$ <br />$ <br />$ <br />Total Amount of Assistance <br />Requested <br />$ .216i 013 1%v <br />'Add additional pages if necessary. if you have multiple properties and you are unable to <br />accept payment on behalf of all of them, please list each property separately and provide the <br />name of the property at the top of each list. <br />Coronavirus Emergency Rental Relief Fund for Landlords Page 1 3 <br />Application <br />