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Name: <br />Address: <br />City, State, Zip; <br />Email: <br />City of Santa Ana <br />Donation Request N-2018-172-01 <br />City Manager's Office — M-31 <br />20 Civic Center Plaza <br />P.O. Box 1988 <br />Santa Ana, CA 92702 <br />(714) 647-5200 <br />Title; 0 0- <br />17 <br />phone: 7/c( 6o6-��vo <br />,Fax: '71c( 2 y -a —C 7'�18 <br />Name: 114 CI ltC2 I Sof L� e �Xd W J Gf ro <br />Tax-Exampt Status: Is your organization <br />zation a non-profit or public Fox -exempt organization as <br />defined under Section 501(c)(3) of the Internal Revenue Code? Select One: ye No <br />If No, you will only qualify for a credit for City -related costs for your request (i. e permit fees, <br />staff time, rental rates for facilities 0, equipment, sto.).Costs for City services very and if it Yes, <br />approved, credit may or may not cover full cost of requested City services, Tax ID #: <br />L) <br />CRY Services Credit $ Date Needed: <br />Amount Requested: _2,__,,,�AayofICounolImamlon: Please Choose From the List Below <br />Direct Payment Amount <br />Requested: $ $500 Event Data: n9M,._"2oaEvent Time6 V0 PULIDO <br />on: S.S C <br />C <br />_45 <br />Event Location: 4) <br />Address, Ofty, State, Zp Q r 'S & (_ <br />(// <br />Description of �t1t Sit QL C'L V e 1� A �i ckc(' ( "Slt Qo vo Q -r C W C_ co <br />�V't­ - <br />Event / Purpose: 40 Qeke6f.�A.Q 0,r <br />Ck Cl <br />IQ <br />+�,v­e' LU'� <br />Community Benefit: ;-')A (^�( ckk t 1A 4t' I m '3 <br />fe 3+CCD,:n'(� Qt't�4 Ft�(e'Lj"'P5 4 )-()c)e (9+ Oct T <br />Applicant Signature: Date: <br />Mail: City Managers Office -M-31 <br />20 Civic Center Plaza <br />P.O. Box 1988 <br />Santa Ana, CA 92702 <br />0 "J%) YES <br />Email: donation request@santa-ana.org <br />Fax: (714) 647-6954 <br />Exhibit 1 <br />August 21, 2018 <br />$500 <br />Revised 812512015 <br />