4/10/2024 12:02 PM FILED IN OFFICE OF TIFFANY M. RUSSELL CLERK OF COURT ORANGE COUNTY FL
`
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`4/10/2024 12:02 PM FILED IN OFFICE OF TIFFANY M. RUSSELL CLERK OF COLJK I
`
`til-tHINt..,m LAJUIN I
`
`1
`
`A. Eligibility
`Completed by sky088770@gmoil.com on 3/22/2024 9:08 AM
`
`Case Id:
`51532
`Name: Reyes, Denisse - ERA1
`Report Id:
`9490
`
`A. Eligibility
`
`The Emergency Rental Assistance Program is designed to provide funds to renters who are behind on rent due to COVID-19 impacts.
`Funds will be provided for rental arrears to the Landlord on behalf of approved Tenants. Please complete the eligibility screening
`below to help determine if you meet the minimum requirements to apply for the program.
`A.1. Is your household income below the 80% area median income level?
`Yes
`
`Effective as of May2023,
`Size.
`2
`4
`6
`7
`$49,150.00 $56,200.00 $63,200.00 $70,200.00 $75,850.00 $81,450.00 $87,050.00 $92,700.00
`.2. Is the rental property in question your primary residence?
`Yes
`
`Household
`
`Income
`
`i A
`
`1
`
`-0
`
`3
`
`n,
`
`5
`
`8
`
`A.3. Is the rental property in question located within Orange County, Florida?
`Yes
`
`A.4 Is the rental property in question located outside of the city limits of the City of Orlando?
`
`Yes
`
`A.5 Do you have documented proof that you cannot pay your rent due to a financial hardship OR of loss of income
`related to COVID-19?
`Yes
`
`A.6. Have you received less than 18 months of combined assistance from any other Emergency Rental Assistance
`Program including the State of Florida (OUR Florida) and the City of Orlando?
`Yes
`
`A.7. Has your household received less than $20,000 from Orange County's Emergency Rental Assistance (ERA)
`Program(s). This includes ERA1 and ERA2.
`Yes
`
`TOP I
`S/—
`\‘‘._ /
`
`IF YOU ANSWERED NO TO ANY OF THESE QUESTIONS, YOU ARE NOT ELIGIBLE FOR THE
`ORANGE COUNTY EMERGENCY RENTAL ASSISTANCE PROGRAM.
`
`Printed By: Denisse Reyes on 3/22/2024
`
`It Neighborly Software
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`1 of 30
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`4/10/2024 12:02 PM FILED IN OFFICE OF TIFFANY M. RUSSELL CLERK OF COURT ORANGE COUNTY FL
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`Printed By: Denisse Reyes on 3/22/2024
`
`011 Neighborly Software
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`2 of 30
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`4/10/2024 12:02 PM FILED IN OFFICE OF TIFFANY M. RUSSELL CLERK OF COURT ORANGE UUUN Y l-L
`
`B. Tenant Information
`Completed by sky088770@gmail.com on 3/22/2024 9:12 AM
`
`Case Id:
`51532
`Name: Reyes, Denisse - ERA1
`9490
`Report Id:
`
`B. Tenant Information
`
`Please provide the following information on this page AND on the "household members" page. Please note this information does
`not transfer to the household members page.
`
`Number of individuals in your household
`3
`
`PRIMARY TENANT
`8.1. Tenant First Name:
`Denisse
`
`B.2. Tenant Last Name:
`reyes
`
`B.3. Home Address
`1124 windmill grove circle orlando, FL 32828
`
`8.4. Mailing Address
`1124 windmill grove circle orlando, FL 32828
`
`B.5. Telephone Number
`(240) 584-5037
`
`Do you agree to receive text messages regarding your
`application from the Emergency Rental Assistance
`Program? If yes, please provide the name of your cell
`phone provider (for example, AT&T, TMobile, MetroPCS,
`etc.).
`Yes
`
`CO-TENANT (IF APPLICABLE)
`B.10. Co-Tenant First Name:
`
`B.11. Co-Tenant Last Name:
`
`B.12. Home Address
`
`B.13. Telephone Number
`
`B.14. E-Mail
`
`B.15 Are there any children in the household under 18
`years old?
`Yes
`
`Name of cell phone provider:
`tmobile
`
`B.6. E-Mail
`sky088770_@gmail.com
`
`B.7. Emergency Contact Name
`
`B.8. Emergency Contact Phone Number
`Printed By: Denisse Reyes on 3/22/2024
`
`piNeighborly Software
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`4/10/2024 12:02 PM FILED IN OFFICE OF TIFFANY M. RUSSELL CLERK OF COURT ORANGE COUNTY FL
`
`Is any household member currently receiving
`B.9.
`unemployment compensation for at least the past 90
`days and can provide documentation?
`No
`
`Note: If you select "Yee, you must upload recent
`unemployment documentation from the DEO.
`
`ElUnemployment Documentation
`**No files uploaded
`
`Printed By: Denisse Reyes on 3/22/2024
`
`4 of 30
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`4/10/2024 12:02 PM FILED IN OFFICE OF TIFFANY M. RUSSELL CLERK OF COURT ORANGE COUNTY FL
`
`C. Household Members
`Completed by sky088770@gmail.com on 3/22/2024 9:12 AM
`
`Case Id:
`51532
`Name: Reyes, Denisse - ERA1
`9490
`Report Id:
`
`C. Household Members
`
`List all members of the household below. Please start with the Primary Tenant, which is the same
`as the Primary Tenant
`listed in
`Section B ("Tenant Information") on the prior page. Submission of the requested demographic information is required by the Federal
`Government
`for data collection purposes only. Such information shall not, in any way, factor into whether or not a Program
`Application is approved. Note: You must include yourself (person applying) in this list of household members and the number of
`household members in this section must match the number of household members in Tenant
`Information.
`
`Name:
`
`Denisse Marie Reyes
`
`Employer:
`
`Not employed
`
`Demographics:
`
`Name:
`
`Anthony Hernandez
`
`Employer:
`
`Not employed
`
`Demographics:
`
`Name:
`
`Bella Hernandez
`
`Employer:
`
`Not employed
`
`Demographics:
`
`Total Household Members: 3
`
`12/03/1987
`Relationship to Head of Household:
`Head of household's child
`Race: Refuse to Answer
`Ethnicity: Hispanic or Latino
`Gender: Male
`
`12/31/2005
`Relationship to Head of Household:
`Head of household's child
`Race: Refuse to Answer
`Ethnicity: Hispanic or Latino
`Gender: Male
`
`07/31/2010
`Relationship to Head of Household:
`Head of household's child
`Race: Refuse to Answer
`Ethnicity: Hispanic or Latino
`Gender: Female
`
`Printed By: Denisse Reyes on 3/22/2024
`
`5 of 30
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`4/10/2024 12:02 PM FILED IN OFFICE OF TIFFANY M. RUSSELL CLERK OF COURT ORANGE COUNTY FL
`
`D. Income Verification
`
`Completed by sky088770@gmail.com on 3/22/2024 9:15 AM
`
`Case Id:
`Name:
`Report Id:
`
`51532
`Reyes, Denisse - ERA1
`9490
`
`Household income Verification
`
`Select one of the FOUR options outlined below for reporting/entering your household income and follow the instructions for that
`option. NOTE: You must use the same type of income for all members of your household.
`
`Option 1: Filed Tax Return/s
`Enter the "adjusted gross income" (line 11) from your 2022 or more
`tax return filed with the IRS and upload the first two
`recent
`pages of the filed tax return. To use this option, you MUST provide documentation that your return was filed by a third-party
`preparer with a filing receipt or by electronic filing confirmation.
`If more than one person filed a tax return in your household, you
`must 1) add all the amounts from line #11 of each tax return 2) enter the total
`in the income box that will appear when you select
`this option and 3) upload all filed tax returns for your household. Note: If all adult household members are not included in your tax
`return/s, you are not allowed to use this option and must choose one of the other options below.
`
`Option 2: Categorical Eligibility
`Provide documentation of receiving benefits from an income-based local, state, and federal government program. Uploaded
`paperwork MUST show the name and address of the person receiving the benefits and MUST have been issued on or after January 1,
`2023 from programs including: Low Income Home Energy Assistance Program (LIHEAP),
`Supplemental Nutrition Assistance
`Program (SNAP), or any other local, state and federal government assistance programs that verify the household as low-income.
`Note: If all household members are not
`included in benefits document, you are not allowed to use this option.
`
`Option 3: Low-Income Qualified Community
`Verify that your address is located within a U.S. Census tract
`identified as a low-moderate income community. To see if your
`household qualifies to use this option, check your address on this map: ERAP Census Tract Address Lookup. If your address shows
`within a purple area, you may choose this option to verify your household income.
`
`Option 4: Income for Past 60 Days
`Enter income information for the past 60 days for every adult household member for each type of income following the instructions
`below.
`If a household member has zero income, then add "No Income" as an income source from the Dropdown menu. Note: You
`will need to upload 30 days of income documents for each type of income for each family member. Additional documentation will
`be required for any adult household member with zero income. For this option, you will need to enter the total household income
`from all sources
`including but not limited to earned income,
`benefits, Veterans benefits, child support, alimony,
`pensions, etc.
`
`Orange County Notice Regarding Collection of
`The following disclosure is being made pursuant to section 119.071(5), Florida Statutes.
`of applicants and household members are requested because this information has been determined to be
`imperative for the performance of the duties and responsibilities prescribed by law under grants and programs operated by Orange
`will be used to:
`County.
`
`1. Verify an applicant's identity
`2. Verify household size
`3. Verify household income
`
`A
`
`•
`
`collected pursuant to this notice can only be used by Orange County for the purposes specified above.
`I may request an oral or written explanation of the information prior to accepting these terms.
`Printed By: Denisse Reyes on 3/22/2024
`
`Neighborly Software
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`4/10/2024 12:02 PM FILED IN OFFICE OF TIFFANY M. RUSSELL CLERK OF COURT ORANGE COUNTY FL
`
`• The acceptance of the Agreement will be good for One Year from the Date of Acceptance unless terminated by me.
`
`2021 or more
`recent Federal income Tax Return (1st two pages) *Required
`2022_TaxReturn (1).pdf
`
`*I will certify my household annual
`income by using my 2022 or more
`recent Federal Income Tax Return (upload required).
`°I will certify that my household annual income based on participation in another income-based state or
`federally funded assistance
`program such as SNAP, LIHEAP, WIC, TANF, etc.
`01 will certify that my household address is within a U.S. Census identified low-moderate income community. Please note that the
`program will verify your address qualifies to use this option.
`°I will certify my annual household income by documenting each household member's income source(s)
`
`Household Income Summary
`
`Income Limits Used
`
`# of Household Members
`Approval Threshold
`AMI @ Threshold
`
`AMI Table
`
`AMI = Area Median Income
`Household
`1 people
`Size
`AMI 100%
`AMI 80%
`
`$0.00
`$42,750.00
`
`Staff Certification
`
`Household Adjusted Annual Income
`
`$14,911.00
`
`2021 HUD
`Limits
`3
`80.00%
`$54,950.00
`
`2 people
`
`3 people
`
`4 people
`
`5 people
`
`6 people
`
`7 people
`
`8 people
`
`$0.00
`$48,850.00
`
`$0.00
`$54,950.00
`
`$0.00
`$61,050.00
`
`$0.00
`$65,950.00
`
`$0.00
`$70,850.00
`
`$0.00
`$75,750.00
`
`$0.00
`$80,600.00
`
`Applicant Signature
`
`Co-Applicant Signature
`
`Printed By: Denisse Reyes on 3/22/2024
`
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`4/10/2024 12:02 PM FILED IN OFFICE OF TIFFANY M. RUSSELL CLERK OF COURT ORANGE COUNTY I-L
`
`E. COVID-19/Financial Impact
`Completed by sky088770@gmail.com on 3/22/2024 9:19 AM
`
`Case Id:
`51532
`Name: Reyes, Denisse - ERA1
`Report Id:
`9490
`
`E. COVID-19/ Financial Impact
`
`Please review the information below and select the option that best applies to your household.
`
`E.1. Did your household experience a financial hardship due to or during COVID-19 OR a recent unforeseen rent
`increase of over 10%?
`Yes
`
`If you checked "Yes," check the appropriate box below AND upload supporting documentation of your impact. If you
`checked "No," you do not qualify for this program.
`
`E.2. Please select the reason
`Financial Hardship
`
`you are applying for rental assistance:
`
`You selected "Financial Hardship" as your reason for applying. Please explain in detail your household's recent
`financial hardship in the box below and upload documentation to verify the financial hardship is the direct cause of
`your falling behind on rent.
`loss of work and no stable income to meet debt
`
`Supporting Documentation
`ECPlease upload your recent Financial Hardship documentation such as letter from employer, loss of self-
`employment income, paystubs showing reduction in hours, an unanticipated basic expense increase, etc. Please note
`that these are examples of documents to upload. Provide as many as needed to document your impact and verify
`your need for rental assistance relative to the rent
`requested. *Required
`Denisse Reyes employment verification.pdf
`
`E.3. IMPACT CERTIFICATION
`WARNING: Processing of your application will be delayed if you do not provide supporting documentation.
`Instructions: Read the following carefully. By checking the boxes below, you are providing legally binding and
`enforceable certification that you understand and agree with the following statements.
`
`By checking the boxes below as part of my application for the Orange County Emergency Rental Assistance Program, I,
`as the Primary Tenant on behalf of my household, do hereby:
`
`EiCertify to the truth and accuracy of the information provided in the above SECTION E.1
`Printed By: Denisse Reyes on 3/22/2024
`
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`4/10/2024 12:02 PM FILED IN OFFICE OF TIFFANY M. RUSSELL CLERK OF COURT ORANGE COUNTY FL
`
`lí Certify that
`
`l am experiencing housing instability.
`
`ElUnderstand and acknowledge that:
`A. The County may rely upon the information provided in this form when reviewing the completed application for
`approval;
`B. Under Florida law, knowingly making a false statement
`in writing with the intent to mislead a public servant
`in the
`performance of his or her official duty is a misdemeanor of the second degree, punishable as provided in s. 775.082 or
`s. 775.083; and
`C. This form is being used to determine federal funding eligibility and Section 1001 of Title 18 of the U.S. Code makes
`it a criminal offense to make willful false statements
`to any Department or Agency of the United States as to any
`matter within its jurisdiction.
`
`Authorized Signature
`DenisseReyes
`Electronically signed by sky088770@gmail.com on 3/22/2024 9:19 AM
`
`Printed By: Denisse Reyes on 3/22/2024
`
`p. Neighborly Softwarc-
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`9 of 30
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`4/10/2024 12:02 PM FILED IN OFFICE OF TIFFANY M. RUSSELL CLERK OF COURT ORANGE COUNTY FL
`
`F. Rent Assistance Requested
`Completed by sky088770@gmail.com on 3/22/2024 9:28 AM
`
`Case Id:
`51532
`Name: Reyes, Denisse - ERA1
`9490
`Report Id:
`
`Assistance Request
`
`for each month you are requesting in rental assistance due to your household's COVID-19 impact. For instance, if
`Fill out the amount
`you require assistance for $1,000 of rent missed in January 2022, but only $500 of rent missed in February 2022, then you would fill
`out $1,000 in January 2022 and $500 in February 2022. Do not include any late fees or penalties. Please note that past due rent will
`be verified by the ledger submitted by the landlord.
`
`RENTAL ASSISTANCE REQUESTED
`F.1. Has your household received a late or eviction notice
`landlord?
`from your
`Yes
`
`LANDLORD INFORMATION
`F.4. Landlord/Entity Name (please verify email and
`update if needed)
`Deerwood
`
`If Yes, you must upload the late or eviction notice.
`2 Notice
`IM G_0460.jpg
`
`Warning: Failure to upload notice will delay the
`processing of your application.
`
`F.2. What is your current monthly base rent?
`$830.00
`
`F.3. Rent request by month.
`
`January 2022
`$0.00
`
`February 2022
`$0.00
`
`March 2022
`$0.00
`
`April 2022
`$0.00
`
`May 2022
`$0.00
`
`F.5. Landlord Phone Number (please verify email and
`update if needed)
`(407) 282-5070
`
`F.6. Landlord Email (please verify email and update if
`needed)
`_mpenal@suncommunities.com
`
`F.7. What is the name of the business or
`individual that
`to? For example, Shady Pines
`you pay your rent
`Apartments or John Smith
`Deerwood
`
`rent?
`
`F.8. How do you pay your
`0 Check
`2 Money Order
`2 Payment Portal
`El Payment App (Zelle, Paypal)
`ElElectronic Payment
`
`Printed By: Denisse Reyes on 3/22/2024
`
`10 of 30
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`4/10/2024 12:02 PM FILED IN OFFICE OF TIFFANY M. RUSSELL CLERK OF COURT ORANGE COUNTY FL
`
`June 2022
`$0.00
`
`July 2022
`$0.00
`
`August 2022
`$0.00
`
`September 2022
`$0.00
`
`October 2022
`$0.00
`
`November 2022
`$0.00
`
`December 2022
`$0.00
`
`January 2023
`$0.00
`
`February 2023
`$800.00
`
`March 2023
`$800.00
`
`April 2023
`$800.00
`
`May 2023
`$800.00
`
`June 2023
`$800.00
`
`July 2023
`$800.00
`
`August 2023
`$800.00
`
`September 2023
`$800.00
`Printed By: Denisse Reyes on 3/22/2024
`
`DiNeighborly Software
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`4/10/2024 12:02 PM FILED IN OFFICE OF TIFFANY M. RUSSELL CLERK OF COURT ORANGE COUNTY FL
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`October 2023
`$800.00
`
`November 2023
`$800.00
`
`December 2023
`$800.00
`
`January 2024
`$820.00
`
`February 2024
`$800.00
`
`March 2024
`$800.00
`
`April 2024
`$800.00
`
`May 2024
`$0.00
`
`June 2024
`$0.00
`
`July 2024
`$0.00
`
`August 2024
`$0.00
`
`September 2024
`$0.00
`
`October 2024
`$0.00
`
`November 2024
`$0.00
`
`December 2024
`$0.00
`
`Printed By: Denisse Reyes on 3/22/2024
`
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`4/10/2024 12:02 PM FILED IN OFFICE OF TIFFANY M. RUSSELL CLERK OF COURT ORANGE COUNTY FL
`
`G. Prior Assistance Received
`Completed by sky088770@gmail.com on 3/22/2024 9:30 AM
`
`Case Id:
`51532
`Name: Reyes, Denisse - ERA1
`Report Id:
`9490
`
`G. Prior Assistance Received
`
`Assistance provided under the Emergency Rental Assistance Program for households economically impacted by COVID-19 may not
`exceed 18 months of a household's monthly unmet housing cost. List all other sources of rent assistance received from local
`governments, the State (OUR Florida Program), other state and/or federal programs, ERAP1, the Orange County Eviction Diversion
`Program, non-profit organizations, or faith-based organizations.
`
`PRIOR ASSISTANCE RECEIVED
`G.1 Has anyone in your household applied for or received any rental assistance from any source (local, state, federal,
`private) from March 2020 through the current month?
`
`If you select yes, proceed with this section.
`If you select no, go to the bottom of the page and click on "Complete and Continue" and proceed to the next section.
`Yes
`
`G.2. List the housing assistance that you have already received each month, where applicable. List all of the sources of
`financial and/or housing assistance (the name of the local, state, federal or private organization).
`
`G.3 Upload Document(s) About Housing Assistance
`ElUpload Document(s) here
`**No files uploaded
`
`March 2020
`$0.00
`
`March Assistance Source
`
`April 2020
`$0.00
`
`April Assistance Source
`
`May 2020
`$0.00
`
`May Assistance Source
`
`June 2020
`Printed By: Denisse Reyes on 3/22/2024
`
`NNeighborly Software
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`4/10/2024 12:02 PM FILED IN OFFICE OF TIFFANY M. RUSSELL CLERK OF COURT ORANGE COUNTY FL
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`$0.00
`
`June Assistance Source
`
`July 2020
`$0.00
`
`July Assistance Source
`
`August 2020
`$0.00
`
`August Assistance Source
`
`September 2020
`$0.00
`
`September Assistance Source
`
`October 2020
`$0.00
`
`October Assistance Source
`
`November 2020
`$0.00
`
`November Assistance Source
`
`December 2020
`$0.00
`
`December Assistance Source
`
`January 2021
`$0.00
`
`January Assistance Source
`
`Printed By: Denisse Reyes on 3/22/2024
`
`14 of 30
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`4/10/2024 12:02 PM FILED IN OFFICE OF TIFFANY M. RUSSELL CLERK OF COURT ORANGE COUNTY FL
`
`February 2021
`$0.00
`
`February Assistance Source
`
`March 2021
`$1,300.00
`
`March Assistance Source
`Neighborly
`
`April 2021
`$0.00
`
`April Assistance Source
`
`May 2021
`$0.00
`
`May Assistance Source
`
`June 2021
`$0.00
`
`June Assistance Source
`
`July 2021
`$0.00
`
`July Assistance Source
`
`August 2021
`$0.00
`
`August Assistance Source
`
`September 2021
`$0.00
`
`September Assistance Source
`
`Printed By: Denisse Reyes on 3/22/2024
`
`r16ghborly Software
`
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`4/10/2024 12:02 PM FILED IN OFFICE OF TIFFANY M. RUSSELL CLERK OF COURT ORANGE COUNTY FL
`
`October 2021
`$0.00
`
`October Assistance Source
`
`November 2021
`$0.00
`
`November Assistance Source
`
`December 2021
`$0.00
`
`December Assistance Source
`
`January 2022
`$0.00
`
`January Assistance Source
`
`February 2022
`$0.00
`
`February Assistance Source
`
`March 2022
`$0.00
`
`March Assistance Source
`
`April 2022
`$0.00
`
`April Assistance Source
`
`May 2022
`$0.00
`
`May Assistance Source
`Printed By: Denisse Reyes on 3/22/2024
`
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`4/10/2024 12:02 PM FILED IN OFFICE OF TIFFANY M. RUSSELL CLERK OF COURT ORANGE COUNTY FL
`
`June 2022
`$0.00
`
`June Assistance Source
`
`July 2022
`$0.00
`
`July Assistance Source
`
`August 2022
`$0.00
`
`August Assistance Source
`
`September 2022
`$0.00
`
`September Assistance Source
`
`October 2022
`$0.00
`
`October Assistance Source
`
`November 2022
`$0.00
`
`November Assistance Source
`
`December 2022
`$0.00
`
`December Assistance Source
`
`January 2023
`$0.00
`
`Printed By: Denisse Reyes on 3/22/2024
`
`17 of 30
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`114 Neighborly Software
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`

`

`4/10/2024 12:02 PM FILED IN OFFICE OF TIFFANY M. RUSSELL CLERK OF COUR I UKHN.
`
`UUl.1l
`
`rL
`
`January Assistance Source
`
`February 2023
`$0.00
`
`February Assistance Source
`
`March 2023
`$0.00
`
`March Assistance Source
`
`April 2023
`$0.00
`
`April Assistance Source
`
`May 2023
`$0.00
`
`May Assistance Source
`
`June 2023
`$0.00
`
`June Assistance Source
`
`July 2023
`$0.00
`
`July Assistance Source
`
`August 2023
`$0.00
`
`August Assistance Source
`
`September 2023
`$0.00
`Printed By: Denisse Reyes on 3/22/2024
`
`N6ghborty Software
`
`18 of 30
`
`

`

`4/10/2024 12:02 PM FILED IN OFFICE OF TIFFANY M. RUSSELL CLERK OF COURT ORANGE COUNTY FL
`
`September Assistance Source
`
`October 2023
`$0.00
`
`October Assistance Source
`
`November 2023
`$0.00
`
`November Assistance Source
`
`December 2023
`$0.00
`
`December Assistance Source
`
`January 2024
`$0.00
`
`January Assistance Source
`
`February 2024
`$0.00
`
`February Assistance Source
`
`March 2024
`$0.00
`
`March Assistance Source
`
`April 2024
`$0.00
`
`April Assistance Source
`
`May 2024
`Printed By: Denisse Reyes on 3/22/2024
`
`alNeighborly Software
`
`19 of 30
`
`

`

`4/10/2024 12:02 PM FILED IN OFFICE OF TIFFANY M. RUSSELL CLERK OF COURT ORANGE COUNTY FL
`
`$0.00
`
`May Assistance Source
`
`June 2024
`$0.00
`
`June Assistance Source
`
`July 2024
`$0.00
`
`July Assistance Source
`
`August 2024
`$0.00
`
`August Assistance Source
`
`September 2024
`$0.00
`
`September Assistance Source
`
`October 2024
`$0.00
`
`October Assistance Source
`
`November 2024
`$0.00
`
`November Assistance Source
`
`December 2024
`$0.00
`
`December Assistance Source
`
`Printed By: Denisse Reyes on 3/22/2024
`
`20 of 30
`
`Neighborly Software
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`

`

`4/10/2024 12:02 PM FILED IN OFFICE OF TIFFANY M. RUSSELL CLERK OF COURT ORANGE COUNTY FL
`
`October 2020
`$0.00
`
`October Assistance Source
`
`November 2020
`$0.00
`
`November Assistance Source
`
`December 2020
`$0.00
`
`December Assistance Source
`
`January 2021
`$0.00
`
`January Assistance Source
`
`February 2021
`$0.00
`
`February Assistance Source
`
`March 2021
`$0.00
`
`March Assistance Source
`
`April 2021
`$0.00
`
`April Assistance Source
`
`May 2021
`$0.00
`
`May Assistance Source
`
`Printed By: Denisse Reyes on 3/22/2024
`
`21 of 30
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`118 Neighborly Software
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`

`

`4/10/2024 12:02 PM FILED IN OFFICE OF TIFFANY M. RUSSELL CLERK OF COURT ORANGE COUNTY FL
`
`June 2021
`$0.00
`
`June Assistance Source
`
`July 2021
`$0.00
`
`July Assistance Source
`
`August 2021
`$0.00
`
`August Assistance Source
`
`September 2021
`$0.00
`
`September Assistance Source
`
`October 2021
`$0.00
`
`October Assistance Source
`
`November 2021
`$0.00
`
`November Assistance Source
`
`December 2021
`$0.00
`
`December Assistance Source
`
`January 2022
`$0.00
`
`January Assistance Source
`Printed By: Denisse Reyes on 3/22/2024
`
`Neig bor 1 y Software
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`22 of 30
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`

`

`4/10/2024 12:02 PM FILED IN OFFICE OF TIFFANY M. RUSSELL CLERK OF COURT ORANGE COUNTY FL
`
`February 2022
`$0.00
`
`February Assistance Source
`
`March 2022
`$0.00
`
`March Assistance Source
`
`April 2022
`$0.00
`
`April Assistance Source
`
`May 2022
`$0.00
`
`May Assistance Source
`
`June 2022
`$0.00
`
`June Assistance Source
`
`July 2022
`$0.00
`
`July Assistance Source
`
`August 2022
`$0.00
`
`August Assistance Source
`
`September 2022
`$0.00
`
`Printed By: Denisse Reyes on 3/22/2024
`
`PINeighborly Software
`
`23 of 30
`
`

`

`4/10/2024 12:02 PM FILED IN OFFICE OF TIFFANY M. RUSSELL CLERK OF COURT ORANGE COUNTY I-L
`
`September Assistance Source
`
`October 2022
`$0.00
`
`October Assistance Source
`
`November 2022
`$0.00
`
`November Assistance Source
`
`December 2022
`$0.00
`
`December Assistance Source
`
`January 2023
`$0.00
`
`January Assistance Source
`
`February 2023
`$0.00
`
`February Assistance Source
`
`March 2023
`$0.00
`
`March Assistance Source
`
`April 2023
`$0.00
`
`April Assistance Source
`
`May 2023
`$0.00
`Printed By: Denisse Reyes on 3/22/2024
`
`01 t\leighborly Software
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`24 of 30
`
`

`

`4/10/2024 12:02 PM FILED IN OFFICE OF TIFFANY M. RUSSELL CLERK OF COURT ORANGE COUNTY FL
`
`May Assistance Source
`
`June 2023
`$0.00
`
`June Assistance Source
`
`July 2023
`$0.00
`
`July Assistance Source
`
`August 2023
`$0.00
`
`August Assistance Source
`
`September 2023
`$0.00
`
`September Assistance Source
`
`October 2023
`$0.00
`
`October Assistance Source
`
`November 2023
`$0.00
`
`November Assistance Source
`
`December 2023
`$0.00
`
`December Assistance Source
`
`January 2023
`Printed By: Denisse Reyes on 3/22/2024
`
`PINeighborly Software-
`
`25 of 30
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`

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`4/10/2024 12:02 PM FILED IN OFFICE OF TIFFANY M. RUSSELL CLERK OF COURT ORANGE COUNTY FL
`
`$0.00
`
`January Assistance Source
`
`February 2023
`$0.00
`
`February Assistance Source
`
`Printed By: Denisse Reyes on 3/22/2024
`
`26 of 30
`
`INNeighborly Software
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`

`

`4/10/2024 12:02 PM FILED IN OFFICE OF TIFFANY M. RUSSELL CLERK OF COURT ORANGE UOUN I Y I-L
`
`H. Required Documents
`Completed by sky088770@gmall.com on 3/22/2024 9:36 AM
`
`Case Id:
`51532
`Name: Reyes, Denisse - ERA1
`Report Id:
`9490
`
`H. Required Documents
`
`Please provide the following information.
`
`Warning: Failure to upload all required documents will delay the processing of your application.
`
`EValid Government Issued Photo ID with an Orange County address for all household members (18 years of age
`
`or older) *Required
`image() (10).jpeg
`imagel (1).jpeg
`
`Rental/Lease Agreement / Documentation that Shows Rental Arrangement *Required
`lease 1.jpeg
`lease2.jpeg
`image() (11).jpeg
`
`EJAny other document related to COVID-19 or rental assistance request - Optional
`**No files uploaded
`
`Printed By: Denisse Reyes on 3/22/2024
`
`1111 1•1eighborLy Softwaro
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`27 of 30
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`

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`4/10/2024 12:02 PM FILED IN OFFICE OF TIFFANY M. RUSSEL
`
`Submit
`
`Completed by sky088770@gmail.com on 3/22/2024 9:37 AM
`
`Case Id:
`51532
`Name: Reyes, Denisse - ERA1
`Report Id:
`9490
`
`Submit
`
`A.
`B.
`
`C.
`
`E.
`
`F.
`
`fictitious, or
`
`Once an application is submitted, it can only be "Re-opened" by your Case Reviewer,.
`Tenant Certifications, Affirmations, Representations, and Agreement to Orange County's Emergency Rental
`Assistance Program's Terms and Conditions
`Section 1: Under penalty of perjury, I hereby personally certify and affirm the following:
`I am an adult and at least 18 years of age.
`I am an authorized Tenant responsible for the rent in full or
`in part and am authorized to submit this
`application on behalf of my household.
`I am authorized to legally bind myself and my household to the requirements, terms, and conditions of both
`participating in, and receiving payment pursuant to, Orange County's Emergency Rental Assistance Program.
`D. That the application information provided on behalf of my household as Tenant is true and accurate to the
`best of my knowledge.
`I am aware that any payment that may be provided to the Landlord by Orange County on the household's
`behalf through this Program will be made by use of federal funds and, therefore, I understand that any false,
`fraudulent information, or the omission of any material fact, may subject me to criminal, civil or
`administrative penalties for fraud, false statements, false claims or otherwise. (U.S. Code Title 18, Sections
`3729-3730 and 3801-3812). Additionally, I understand that Chapter 817, Florida Statues, provides that willful
`false statements or misrepresentations concerning income, asset, or
`liability information relating to financial
`condition is a misdemeanor of the first degree, punishable by fines and imprisonment provided under
`sections 775.082 and 775.083, Florida Statutes.
`I have reviewed this application and the requirements, terms, and conditions of both participating in, and
`receiving payment pursuant to, Orange County's Emergency Rental Assistance Program —
`certification and affirmation terms — and fully understand and agree to them on behalf of my household.
`including these
`G. The rental assistance provided by the Orange County Emergency Rental Assistance Program is not duplicative
`of any other Federally funded rental assistance.
`H. That my household is experiencing housing instability.
`Section 2: Pursuant to the foregoing legally binding authority and representations made, under penalty of perjury, I
`hereby certify and affirm the following on behalf of my household:
`A.
`I consent to Orange County, Florida (the "Countr) sharing any and all documentation or
`submitted in relation to the Landlord's participating in, or receiving payment pursuant to, Orange County's
`Emergency Rental Assistance Program with the Federal Government, as well as other agencies, organizations,
`and community partners as the County deems necessary or appropriate.
`I understand that the State of Florida has broad public records laws and that any of the Tenants submitted
`documentation or
`information that is not explicitly confidential or exempt from release under federal or state
`law may be publicly released by the County pursuant to a public records request, or as otherwise deemed
`necessary or appropriate by the County.
`C. That the rental property and rental arrangement that it has with the Landlord for which this application is
`Printed By: Denisse Reyes on 3/22/2024
`
`B.
`
`information
`
`IPS Neighborly Software
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`28 of 30
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`

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`4/10/2024 12:02 PM FILED IN OFFICE OF TIFFANY M. RUSSELL CLERK OF COURT ORANGE COUNTY FL
`
`E.
`
`F.
`
`being submitted meets all of the requirements and criteria for participation in, and receiving payment
`pursuant to, Orange County's Emergency Rental Assistance Program.
`D. That all
`information and documentation that was provided to the County as part of its application for Orange
`County's Emergency Rental Assistance Program is true and accurate to the best of its knowledge.
`I hereby grant permission to, and authorize any bank, employer, property owner/manager, or other public or
`private organization to disclose to Orange County, Florida, any information deemed by the County to be
`necessary to complete this application.
`l understand that Orange County government retains the
`for one (1) year for all
`household members on record who are included in this application for rental assistance for one or more of
`the following purposes.
`1. To verify an applicant's identity;
`2. To verify income;
`3. To verify household size; and
`there is no duplication of assistance.
`4. To ensure
`I understand that the collection of my household's
`for the reasons
`above and that, pursuant to Florida Statutes 119.071 (5),
`confidential and exempt from public disclosure.
`
`G.
`
`may only be used by the program
`collected are
`
`Section 3: In addition to the certifications, affirmations, and representations made in Sections 1 and 2 above, under
`penalty of perjury, I as the Tenant agree to the following general terms and conditions:
`A. The Landlord's acceptance of payment in the approved amount from the County on the Tenant's behalf shall
`grant the Tenant the legal right to enforce the certifications, affirmations, and representations made in
`Sections 2, Paragraph C, against the Landlord in the court of law.
`B. Administering and providing the approved payment on behalf of the Tenant does not,
`in any way, make the
`County or the Federal Government a party to the Landlord and Tenant's the Lease, or
`to any rental
`arrangement existing between the Landlord and the Tenant.
`C. At no point shall the County or the Federal Government be considered to have assumed: (1) responsibility for
`any act or omission of the Landlord or Tenant; or (2) any obligation that the Landlord and Tenant have to one
`another pursuant to the Lease, or
`to any rental arrangement existing between the Landlord and the Tenant.
`D. Neither the County nor
`the Federal Government shall be responsible for, or be held liable for, any damages,
`costs, expenses, or unreasonable fees not covered by the program; however foreseeable or unforeseeable,
`that arise or
`the Landlord or Tenant incur as a result of either's participation in Orange County's Emergency
`Rental Assistance Program. Covered fees can include reasonable charges for late fees, court
`fees, eviction
`fees, and/or legal fees (if any).
`E. Assistance or direction provided to the Landlord or Tenant in the application process by the County or any
`agency working on behalf of the County should not
`in any way be construed as: (1) the County guaranteeing
`approval of such application; or
`(2) an agreement by the County to make payment of any nature to the
`Landlord.
`If any provision found in these certifications, affirmations, or
`terms and conditions is held to be unlawful, void,
`for any reason unenforceable, then that provision shall be deemed severable an