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Certification of Loss of Rent due to the Coronavirus (Exhibit B) <br />The City is required to verify your revenue loss or relit loss due to the Coronavirus to <br />confirm that the City's payment is necessary. Exhibit B of the template Agreement is <br />the following documentation to demonstrate that the landlord has experienced a loss of <br />rent due to the Coronavirus during this same period last year compared to this year. <br />This information should include the entire property, If you have multiple properties and <br />you are unable to accept payment on behalf of all of them, please.list each property <br />separately and provide the name of the property at the top of each list. <br />• Property Name: River House Apartments <br />0 Property Address: 2111 W.17th Street Santa Ana, CA 92706 <br />4 Tax ID for Payment: 65-3099613 <br />a Total rent payments received between January 1, 2019 to June 30, 2019: <br />Nrope <br />ty2rchased 11/23/2020 <br />Total rent payments received between January 1, 2020 to June 30, 2020, <br />$_ N/A Property Purchased on 11/23/2020 <br />Difference in Revenue / Rent between 2.019 to 2020 (Subtract 2020 from 2019); <br />m Revenue Moss or Rent Loss due to the Coronavirus <br />Property Purchased 11123/2020 <br />This program is supported with Federal funding. According to Title 18, Section <br />1001 of the U.S. Code, it is a felony for any person to knowingly and willingly <br />make false or fraudulent statement to any department of the United States <br />Government. By providing my signature below, I certify under penalty of perjury, <br />that all the information on this application is correct to the best of my knowledge <br />and belief, and I acknowledge that such information is subject to verification. I <br />also acknowledge that my failure to provide necessary documents within a <br />reasonable period of time or falsification of this information shall be grounds for <br />my denial of assistance, and that I may be subject to prosecution under the law, <br />authorize the release of said information to local, State and/or federal agencies <br />and to City Santa Ana staff within five years of this date. <br />Landlord Name (Print); Vicki Binford _ Date; 12/9/202,0, <br />Landlord Signature: .l _, Date: 12/15/2020 <br />Please Note: The property was purchased by Advanced Management Company on 11/23/2020. <br />Coronavirus Emergency Rental Relief Fund for Landlords Pine 14 <br />Application <br />