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♦'"'?` City Manager's Office — M-31 <br />�- a Cit of Santa Ana <br />`—'���—" ,a� y 20 Civic Center Plaza <br />(I� Donation Request P.O. Box 1988 <br />'t . — Santa Ana, CA 92702 <br />_- (714) 647.5200 <br />— <br />Name: TISh Leon ile: Prasidenl of Downtown Neighborhood Association <br />serosa: <br />700 W. 3rd. St A208 <br />Icier, State, ata, zip- <br />Santa Ana, CA 92701 <br />Phone: <br />71.4-401-8312 <br />iEmai� l: <br />lety.leonl951@gmail.com <br />Fax: <br />Address, City, State, Zip <br />Name: (Charitable Ventures of Orange County (fiscal sponsor for Downtown Neighborhood Association) <br />Tax -Exempt Status: Is your organization a non-profit or public tax-exempt organization as i <br />defined under Section 501(cX3) of the Internal Revenue Code? Select One: Yes No <br />If No, you will only quarify for a credit for City -related costs for yourrequest (i.e. permil fees, i If Yes, ❑ ❑ <br />stafftime, rental rates for facilites or equipment,etc.).Costs for City services vary and if 20 8756660 i <br />approved, credit may or may not cover full cost of requested City services. ax to #: <br />Return Completed form vias, <br />Mail: City Manager's Office—M-31 Email: donationrequest@santa-ana.org <br />20 Civic Center Plaza Fax: (714) 647-6954 <br />P.O. Box 1988 <br />Santa Ana, CA 92702 <br />city Services Cred—Date Needed: <br />iAmouIt Requested: <br />9/1/ZMa or/Coin ncllmemberi <br />I y <br />Martinez <br />r�r�— <br />iDlrect Pam ant Amour�$ 5OO Event Date: <br />1 0/112 0 1 8 Event Time: <br />l 0-2 <br />— <br />Approved Amount: <br />--i <br />5500 <br />-- - <br />Event Location: <br />Birch Park/SA Senior Center <br />Address, City, State, Zip <br />424 W. 3rd. Sl 92701 <br />3rd Annual International Older Adults Health Fair <br />Description of <br />To celebrate the diversity & culture of the Seniors in SA, the seniors will be the performers and participants. <br />Event I Purpose: <br />Both Seniors centers will participate and all senior apartments will receive flyer's to participate <br />There will be booths with resources for the seniors, plus a health fair that will provide services for all in <br />Community Benefit: <br />attendance. There will be food trucks that will provide lunch for $5 for each senior. Funds are needed to <br />help with meals, and other essentials to put on the event. <br />Applicant Signature: <br />�+ -. <br />7": /moi- Leen,. <br />Date. <br />7�6�2018,;� <br />F _.,. <br />Return Completed form vias, <br />Mail: City Manager's Office—M-31 Email: donationrequest@santa-ana.org <br />20 Civic Center Plaza Fax: (714) 647-6954 <br />P.O. Box 1988 <br />Santa Ana, CA 92702 <br />Revised 01105/2017 <br />ExZYA-20 <br />Donation Request#: <br />Reference ll on all relafed DPVs <br />DR - <br />_— _ <br />ouncg <br />Cil Meeting Date: <br />Au gust 21. 2018 <br />Eligibility Met: <br />.-_.-- <br />YES I NO YES <br />- - <br />— <br />Approved Amount: <br />--i <br />5500 <br />-- - <br />City Manager Signature: <br />--- - - - <br />Date: <br />Revised 01105/2017 <br />ExZYA-20 <br />