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0 <br />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) 647-5200 <br />Nam — QthY16lV1d0 �J[Ll leYf2ZFlue `�PIV1G1 ill <br />Name:— <br />Addres� s: <br />Ltoq F , Sav*A C la (re, Ave , <br />1 ity,scr tate, Zip: <br />SahllA, Pliv-A,Ck '1270b rPhone:(-114) S&LL -2_(03 <br />Email:YMA%k.G�Tierre <br />SIcj ue —'Fax: <br />C rbL+-2_1"1j <br />4Oover F-I2w�ew Ary (; . 001 <br />npt Status: Is your organization a non-profit or public tax-exempt organization as <br />ider Section 501(c)(3) of the Internal Revenue Code? <br />will only qualify for a credit for City -related costs far yourrequest (i.e. permit fees, <br />rental rates fortacilities or equipment, etc.).Costs for City services vary and if <br />credit may or may not cover full cost of requested City services. <br />One: <br />ID p: <br />7M <br />Qon`%o61Regiie's`tj,`--�_ <br />City Services Credit I 435.00 (Date N d: 11( ,1 I�! Tina or01, <br />Amount Requested: SGt Ma orlCouncitmember. . _ ).,_ _ . <br />tract Payment Amount f/ <br />Event-TDa�te: NDv , 9 t20�1tp iEvle�nt'Ti�me:'.t I –r.00 – C150 PM <br />;Requested: �5 <br />r <br />Event Location: <br />I <br />�POrkO�a, _PA V- setNTLL. rout r CA 4277015 <br />(Address. City, State, Zip <br />City Manager Signature: <br />Description of <br />t� tDv I l�l.i�l <br />Event I Purpose: <br />(� <br />S LW d el Se vLgG o -F Co tnM> IA 0 r� <br />Community Benefit: <br />, <br />-�aw�lae`s s4udeu�s of 4_6vev, tlew',evjar� <br />Signature: <br />Applicant� at <br />Mall: City Manager's Office–M-31 Email: donatlonrequest@sante-ana.org <br />20 Civic Center Plaza Fax: (714) 647-6954 <br />P.O. Box 1988 <br />Santa Ana, CA 92702 <br />Crit Eb'l_-t+17L-S' - -- <br />Donation Request N: <br />Reference H on all related DPVs <br />DR - <br />YES I NO YES <br />Council Meeting Date: 11/20/18 <br />Eligibility Met: <br />� Approved Amount: $435*(City Service Credit) <br />I _ <br />City Manager Signature: <br />— <br />----- <br />Date: i _I <br />NOTE: Journal Entry for movie cost <br />1 <br />Revised 0110512017 <br />