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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: 1) 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 file 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 />(209/6) following payment by the City of Santa Ana (809/6). <br />Property Name: b,IA- <br />Property Address: ' (G IG Sr9,qiv rk ,A N A i C:-4 J 2 7d � <br />Tax I® for Payment:> <br />—Full Name of Tenant <br />(as stated n the Lease) <br />Address of Tenant's Rental Unit <br />Total Amount <br />of Rent Arrears <br />Owed <br />n A__r <br />_— <br />Total Amount of Assistance <br />- Requested <br />Add additional pages Jr necessary. It 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 13 <br />Application <br />