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City of Santa Ana <br />u Donation Request <br />city managoes Office- M31 <br />20 Civic Center Plaza <br />P.O. Box 1988 <br />Santa Ana, CA 92702 <br />(714) 647.5200 <br />s a a <br />'Name: Jose J. Rearule: MPNA Treasurer <br />Address; 1516 E. OccidentaL St. <br />City, State, zip: Santa Ana, CA 92707 phone; ' 714-357-6697 <br />Email; madisonparkna@gmaii.com Fax: <br />'Name: I. Madison Park Neighborhood Association (MPNA) <br />Tax -Exempt Status: Is your organization a non-profit or public tax-exempt organization as Select One: !; ❑ ❑ <br />defined under Section 501(e)(3) of the Internal Revenue Code? Yes tlm <br />If No, you will only qualify fora credit for City -related costs Por your request (is. permit fees, 'If Yes <br />staff time, rental rates for facilities or equipment, etc.). Costs for City services vary and if i80-0201690 <br />,approved credit may or may riot coverfull cost of requested City services. Tax ID #: t <br />City services Credit'6/30/18 <br />Amount Requested: .S :Data Needed: MayoriCounoiimember:.Sarmiento <br />(Direct Payment Amount <br />$ 88319 Event Date ,1�$k'Fl !'I iEven Time: lam- fpm <br />:Requested: <br />Event City, Stats, 2!p <br />Citation: <br />Rtltlress, Madison Park 1528 S Standard Ave, Santa Ana, GA 92707 <br />This year residents will complete a 5k walk along the bike trail from Edinger to <br />'Description of :Chestnut Ave. Two police officers are needed at intersections that lack stop signs <br />Eventl Purpose: Ito ensure the safety of the participants. <br />MPNA invites sponsors and community resources; which provi a services to�oitr <br />-.Community Benefit: lcommunity to empower residents to make healthier life choices. We anticipate an <br />;attendance of approximately 1,500, which consist of adults and children. <br />,.'�%';? .,/ oats:���.,�, <br />Applfoant Signature: � '` .fr'°'a'O <br />Mail: City Manager's Office -M-31 Email: donationrequest@santa-ana.org <br />20 Civic Center Plaza Fax: (714) e47-9994 <br />P.O. Sox 1988 <br />Santa Ana, CA 92702 <br />Donation Request tf: OR. '. Counei0 Mooting Dom: <br />EIiglL+ility Mae YES I NO <br />Approved Amount: <br />City Manager eign Aurre: 0att,7, i/v/,5 <br />Revised 4110512017 <br />