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Name: f), Vy J c urQ� t <br />;Title: <br />Address: ' �� B (�C� <br />Q;�y:`,, <br />w..�-,�/s <br />City of Santa Ana <br />City Manager's Office - M-31 <br />20 Civic <br />Email: �/° CL- n O, C.0 �r-" <br />( C vv�Ct <br />Donation Request <br />Donation <br />Center Plaza <br />P.O. Box 1988 <br />�1y' <br />T;` <br />Name: FBb iTax-EW I .I� h rC e care <br />Santa Ana, CA 92702 <br />defined uncle Status: Is your or of the Int a noneven r public tax-exempt organization as <br />defined under section 501(e)(3) of the Intemai Revenue Code? <br />select One: lI��1 <br />I XIYes ❑ No <br />Lf� <br />(714) 647-5200 <br />Name: f), Vy J c urQ� t <br />;Title: <br />Address: ' �� B (�C� <br />Co e,A CL7 --c <br />City, State, ZIP: SQ w /1 �'� C7�1t� <br />J / <br />;Phone: 7� Y 6 (..6 _b/ Vo <br />Email: �/° CL- n O, C.0 �r-" <br />( C vv�Ct <br />Fax: <br />7�� f.. -Y � -b 4�_ <br />Name: FBb iTax-EW I .I� h rC e care <br />defined uncle Status: Is your or of the Int a noneven r public tax-exempt organization as <br />defined under section 501(e)(3) of the Intemai Revenue Code? <br />select One: lI��1 <br />I XIYes ❑ No <br />Lf� <br />If No. you will only qualify for acredit for City -related costs foryourrequest(i.e.permit fees, <br />staff time, rental rates forfacilitfes o, equipment, etc.).Cests for Cityservices vary andif <br />approved, credit may not cover full cost requested City <br />If Yes, <br />Tax ID #: Q , <br />ormey of services. <br />CltyServices Credit <br />Amount Requested: <br />Direct Payment Amount <br />Requested: <br />Event Location: <br />Address, C* State. Lp <br />Description of <br />Event/ Purpose: <br />Community Benefit: <br />Applicant Signature: <br />s Date Needed: i �MayorlCouncilmember: Please Choose From the List Below <br />5' $500 Event Date: c)rl�� Event Timm j MARTINEZ <br />1 ' ff )9W i <br />1 vr'tp('SC-L�c(<iu.S 0� IC -OSS � VLtaSSB�I c��Y6�E'k <br />19) _ <br />�/ Ahnwa( SULr1LrrQ{ ��CllrC g �o�,cPr-� �`� <br />o,I�VlarSG <br />(,IL`c cl SQL moi.. �9-r `{_C.2 �-1-EtrS '�rpcu.,he c`i�^r� IM Ci '�a: �i-�ivC Q.Lc(Fo., <br />^QQ� t 1L-3,4 C -C! C`l "1S/1,1tu1N'KC <br />n, <br />S�ro''i� u`r"4 1_sre'Ljs6,rps ¢ LoOti'r <br />co ut Lit u col <br />\ .Date: <br />Mall: City Managers Office- M31 <br />20 Civic Center Plaza <br />P.O. Box 1988 <br />Santa Ana, CA 92702 <br />Donation Request,' . <br />Elkhl((y f71«at: <br />C;ty Cion.; qcr Slgnafu re: <br />r)R - <br />YE5 t NI) YES <br />Email: donationrequest@santa-ana.org <br />i Fax: (714) 547.9954 <br />Conned Mc -ung LUC: <br />Apprn, _,d Amount: <br />flat• <br />August 21, 2018 <br />$500 <br />Revised 82512015 <br />l <br />