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, <br />2U-312 <br />Cityof Santa ACity Manager'sOff7ce-M-31 <br />anAna <br />20 Civic Center Plaza <br />Donation Request P.O. Box 1988 <br />_ Santa Ana, CA 92702 <br />- (714) 647-5200 <br />'[Deborah <br />,Name: Johnson—rExecuGe Dlrecto� <br />Pddre� <br />2618 San Miguel Drive #284 <br />C1 sr wte, Zip: Newport Beach, CA 92660 nv �e, 714 478-8351 <br />l: debjll@loloud.00m Fes— �— <br />Email: <br />•nizatbon Information <br />Name: <br />Second Chance Orange County <br />Tax -Exempt Status: Is your organization anon -profit or public tax-exempt organization as elect One: <br />�I--� Eldefined under Section 501(c)(3) of the Internal Revenue Code? <br />yea No <br />If No, you will only qualify for a credit for City -related costs for yourrequest (.e. permit fees, �— <br />If Yes, <br />staff time, rentalrates for facilities or equipment,etc.).Costs for City service's vary andif 81-1224869 <br />approved, credit may ormay not coverfull cost of requested City services. [rax lDM <br />City Services Credit iDatNeeded: <br />Requested: <br />Stemberl0 iMayorlCounclimemner. <br />I <br />SOlOflOPmount <br />Direct Payment Amount Event Date Se tember 22 — <br />,Requested: $500 P Event Time: 5-9pm <br />1919 N. Heliotrope Dr. Sania Ana, Ga-92766— <br />a 92706Addres; <br />(Event Location <br />Address;G'N. State, Zip <br />Help augment our CDBG grant inSanta Ana to pay fox -65 ­—gap in t e proms <br />Description of budget. The money raised goes to program services so we can continue to <br />Event) Purpose: provide services to Santa Ana Homeless and recovering alcohol/drug addicts. <br />Inrluftinn-mentorina/rnachina. inh nlacPment FAFSA heln R sunnortive services <br />EcoF11 <br />ttheseo ton o th longer usepu tic services, they pay taxes, <br />they pa roalue, <br />er <br />munity Benefit they pay rent and are no longer on the street, they become productive members <br />of society. <br />�Appllcant S�ture:—F� August 22,2018 <br />Mail: City Manager's Office -M-31 <br />Email: donationmquest@santaana.org <br />20 Civic Center Plaza <br />Fax: (714) 647.6954 <br />P.O. Box 1988 <br />Santa Ana, CA 92702 <br />Donation Request 8: _ DR <br />ne,•nwncononallrera:caonvs Council Meeting Date: 11/20/18 <br />Eligihility Met <br />II <br />YES / NO YES Approved Amount: <br />$500 <br />City Manager Signature <br />Date: <br />I <br />Revised 011052017 <br />, <br />2U-312 <br />