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'� City Manager's Office— M31 <br />r :•. City of Santa Ana 20 Civic Center Plaza <br />Donation Request P.Box 1988 <br />Santa Ane CA 92702 <br />(714) 647-5200 <br />• • e <br />� amN Kevin Cabrera me: Exec. Director <br />ddress: <br />3101 W Harvard St <br />city, State, zip: <br />Santa Ana, Ca. 92704 �Phonr e 714-733-0709 <br />iEmai� — <br />kcabrera@heritagemuseumoc.org Fax: <br />• .. -nization Information <br />Name: <br />IHeritage Museum of Orange County <br />Tax -Exempt Status: Is your organization a non-profit or public tax-exempt organization as Select One: <br />defined under Section 501(c)(3) of the Internal Revenue Code? Z ❑ 1-1Yes No <br />If No, you will only qualify for a credit for City -related costs for yourrequest (i.e. permit fees, r — <br />staff time, rental rates forfacillfies orequipment, etc.).Costs for City services vary and if If Yes, g5-3665050 <br />approved, credit may ormay not cover full cost of requested City services. ax lD#: <br />■• <br />Ity Servic Date Neeaea: October 1 MayorlCoul ncilmember... <br />Amount Requested: i <br />Tinajzro <br />Amountl <br />giroc steed --. <br />equEvent <br />r�—F—i <br />5OO IEventont Date: October 26 <br />Event Time: <br />3 PM — 9 PM <br />Location: <br />eritage Museum of OC <br />[3101 <br />Address, city, state, Zip <br />W Harvard St, Santa Ana, CA. 92704 <br />Description of <br />Event/ Purpose: <br />kull class showing youth how to make and decorate sugar skulls as part <br />FDiae Los Muertos, and Ghosts of OC Trick or Treat on the museum property. <br />These event will be free to the community and we will be inviting SAUSD schools <br />Community Benefit: <br />to participate. <br />Applicant Signature: <br />I' e; a I Zy I tQ1. ,I <br />ID -ate: <br />-form <br />Mr-Jeted via., <br />Mail: city Manager's Office—M-31 <br />Email: donationrequest@santa-ana.org <br />20 Civic Center Plaza <br />Fax: (714) 647-6954 <br />P.O. Box 1988 <br />Santa Ana, CA 92702 <br />Donation Request #: DR - Council Meeting Date: <br />Referance # on all ralawd0PVs _ <br />Eligibility Met: YES I NO I Approved Amount:_— <br />City Manager Signature: Date: <br />Revised 01105/2017 <br />EXHIBIT 3 <br />29A-19 <br />