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City of Santa Ana <br />Donation Request <br />City Manager's Office – M-31 <br />20 Civic Center Plaza <br />P.O. Box 1988 <br />Santa Ana, CA 92702 <br />(714) 547.5200 <br />Iµeln,{-swylRY norer�rnro;n I <br />Name: Peter Mangosing 'Fula:. Chief Instructor <br />ddress: <br />1118 W. Stevens Av. <br />Ply. state, zip: <br />Santa Ana, Ca. 92707 Phone: 714-745-7801 <br />Email: <br />tkksensei@te-kenjutsu-kan.com <br />Fax: <br />Address, City, state, Zip <br />IName: ITe-Kenjutsu-Kan Karate -Do Organization <br />Tax -Exempt Status: Is your organization a non-profit or public tax-exempt organization as <br />defined under Section 501(c)(3) of the Internal Revenue Code? <br />elect Ona: <br />Yes ❑ No <br />If No, you will only qualify lora credit for City -related costs foryourrequest(ie. permit fees, <br />Eligibility Met: <br />YES i NO YES <br />tafftime,rentalratesforfacilitiesorequipment,etc.).CostsforCityservicesvaryandit <br />ryxes� <br />Address, City, state, Zip <br />credit mayor may not cover full cost of requested City services. <br />: <br />#201371172approved, <br />- i <br />:O YY - <br />City Services Credit Data Needed: Ma orlCouncitmemben Solorio <br />��—� <br />mount Requested: <br />Direct Payment Amount <br />500.00 Event Date: 11/11/18 Event Time; 9:00anl <br />Requested: <br />Eligibility Met: <br />YES i NO YES <br />Even/ Location: <br />gerstroff High School <br />F2301 <br />Address, City, state, Zip <br />W. MacArthur Blvd. Santa Ana, Ca. <br />Date: <br />Te-kenjutsu-Kan Karate -Do, 16th Annual, Adlawan Cup Food Drive Karate Championships, Where all <br />Description of <br />competitors are required to donate, 2 -cans of food, 1 small bag of rice or pasta, 1-4 pack of toilet paper or a <br />Event Purpose: <br />4 -pack of paper towels. All donated goods go to the WisPlaoe a Shelter for Women in the City of Santa Ana. <br />The event benefits The WisePlace a shelter for women in Santa Ana. The donated goods are much needed by the women transitioning from <br />Community Benefit: <br />being homeless to self-sufficient and empowered to make a better life for themselves. By bringing our community together to help organize <br />the event it raises awareness to the needs of the ladies of WisePlace. It also benefits ouryoulh in teaching the Importance of community <br />seMce. <br />Applicant Signature: <br />�//e/ <br />Date: -F <br />I <br />Mall: City Manager's Office–M-31 (Email: donationrequest@santaana.org 'I <br />20 Civic Center Plaza Fax: (714) 647.6954 <br />P.O. Box 1988 <br />Santa Ana, CA 92702 <br />Revised 01/05/2017 <br />EXHIBIT 4 <br />29A-16 <br />Donation Request 0: <br />Refcrenca f! on all related DPVs <br />DR- <br />Council MaeBng Date: <br />11/20/18 <br />Eligibility Met: <br />YES i NO YES <br />Approved Amount: <br />$500 <br />City Manager Signature: <br />Date: <br />Revised 01/05/2017 <br />EXHIBIT 4 <br />29A-16 <br />