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Cityof Santa Ana City Manager's Office-hf-71 <br />20 Civic Center Plaza <br />�.-..- <br />k Donation Request P.Santa Ana, CA 92702 <br />(714) 647-5200 <br />u__.. _.._ _ -- ----- __ �.__--___—___._._i <br />r ame: ! Deborah Johnson 4,liq; 1 Ezecutl� ve -6lrect� <br />Address: :2618 San Miguel Drive #284 <br />- —-----....--------- ----- --- - - i-- ---- --- — - <br />-- <br />city,state, zip: (Newport Beach, CA 92860 ,pnnne; 1714 478-8351 <br />Small; Idebj 11@icloud.com Fax: <br />i Name: -- <br />un, am,uu. is yvui uiyawrauun o em,-V,o,n w Vumic uxexenryt OlyeniZaaen as <br />ider Section 501(c)(3) of the Internal Revenue Code? <br />will only qualify for a credit for City -related costs for your request (i.e. permit fees, <br />rental rates for facilities or equipment. etc.). Costs for City services vary and it <br />credit mayor may not cover full omit of neguested City services. <br />:City Services Credit <br />'Amount Requested: <br />5 .,QW- 'Pate Needed: (September 10 NlayorlCouncllmember-I Martinez <br />;Direct Payment Amount <br />Requested: <br />iS 1,000 Event Date: September22 .,Event Time: ,5-9pm <br />lEvent Location: <br />1919 N Heliotrope Dc Santa Ana, Ca 9270fi-------- --J�--------- <br />lAdd,ess. Gly, state, Zip <br />fie raise-funtls to be able to augment our CDBG grant in Santa Ana to pay for the <br />!Description or <br />gap in the program budget. The money raised will go to program services so we <br />'Event 7 Purpose: <br />scan continue to provide services to the Santa Ana Homeless and recovering <br />alanhol/dnln aridintc These sptvices:mPntnrino/r-nachina heln nettinn into <br />Economic va use, tFieseindivTduals no`longer use public services; theyay ta <br />pxes, <br />,Community Benefit <br />'they pay rent and are no longer on the street, they become productive members <br />of society. <br />!Applicant Signature: <br />/ n —� - -'DatelAuguSt 22, 2018 -_ <br />(Mail: City Managoes Office -M31 i Email: donationrequest@santaana.ory � <br />20 Civic Center Placa Fax: (714) 647-6964 i <br />P.O. Box 1988 <br />Santa Ana, CA 92702 <br />Donatinn Request e: DR. <br />Council Meeting Date: October 16, 2018 <br />ti..aa �•c,.. n. ,+:.._,,..: ,. <br />Eligibility ?,let: YESI NO YE. Approved Amount' $1,000 <br />City Manager sign. uue: ... _ .. _ _... _ Date: .. . <br />Revised 01/052017 <br />EXHIBIT 1 <br />29A-8 <br />