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29'-14 <br />�. City Manager's Office — M-31 <br />City of Santa Ana 20 Civic Center Plaza <br />I Donation Request P.O. Box 1988 <br />Santa Ana, CA 92702 <br />'-- (714) 647-5200 <br />• e <br />!lame: rJose•J. Rea IT;d{ e: FMPNA Treasurer <br />�Y <br />I tddress: ( 516 E. Occidental- St. <br />city S te, zip: Santa Ana, CA 92707phone- 714-357-6697 <br />.Email: Imadisonparkna@gmail.com (Fax: i <br />• <br />Name: Madison Park Neighborhood Association (MPNA) <br />Tax -Exempt Status: Is your organization a non-profit or public tax-exempt organization as <br />defined under Section 501(c)(3) of the Internal Revenue Code? (Select One: i Yes ❑ Na <br />IIfNo, you will only qualify for a credit for City -related costs foryour request (i.e. permit fees, 1 <br />staff time, rental rates forfaa7ifies or equipment, etc.). Costs for City services vary and if If Yes, 180-0201690 <br />approved, credit may ormay not coverfull cost of requested Cityservices. 'Tax 10M <br />®•,. <br />City ServicesCredit y —Date Needed: 16/30/18 (Mayor/Councilmember. Sarmiento <br />'Amount Requested: i i <br />)Direct PaymentAmountI r ' 7am- 1 m <br />$ 883.19 Date: IL;2018 !Event Time: p <br />'Event <br />Requested: <br />Event ,ovation: lI Madison Park 1528 S Standard Ave, Santa Ana, CA 92707 <br />Atltlrens, ury, State, Zip , <br />1 i <br />.This year residents will complete -a5 walk along thetike trail from Edinger to <br />Description of Chestnut Ave. Two police officers are needed at intersections that lack stop signs <br />(Event I Purpose: Ito ensure the safety of the participants. <br />MPN community resources <br />invites sponsors and commun, wlilch provide servicesto our <br />community Benefit: 'community to empower residents to make healthier life choices. We anticipate an <br />;attendance of approximately 1,500, which consist of adults and children. <br />i <br />Applicant Signature: Date: <br />! I I <br />Mail: City Manager's Office—M-31 <br />Email: donationmquest@santa na.org <br />20 Civic Center Plaza <br />Fax: (714) 847-6954 <br />P.O. Box 1988 <br />Santa Ana, CA 92702 <br />Donation Request N: j DR - i Council Meeting Date: ; June 19, 2018 <br />Relerebce k on all related 177vs <br />j Eligibility Met: YES I NO YES ^__ Approved Amount: $883.19 <br />City Manager Signature: <br />Date; <br />Revised 01/052017 <br />29'-14 <br />