Laserfiche WebLink
City of Santa Ana <br />I; Donation Request <br />;t <br />Name: I --- -_ <br />Address: ' <br />City, State, Zip: <br />— ---- \7 bX, - <br />Email: <br />(Phone' 7 <br />Fax: <br />Name: I 1 I ` J <br />-- l -I t- S In t �--� rh G( rP _ - N lcc-�-l4_IloLlc{ j <br />Tax-Exempt Status: Is your organization a non -profs or, ublic tax-exempt organizatidn as ;Select One: <br />defined under Section 501(c)(3) of the Internal Revenue ede7 <br />If No. you will only qualiyfor acredtfor City -related costs foryourrequest(i.e.permitfees , r — <br />staNlime, rental rates for facilities or equipment,etc.). Costs for City services vaty andif if Yes, <br />approved, credit may or may not cover full cost of requested City services`Tax ID 11% <br />city Services Credit I I <br />Amount Requested: 11�t1-�t�} ;Date Needed: `h <br />'Direct Payment Amount I <br />Requested:IS$.1,000Event Date: <br />'Event Location /� <br />I tti,, i / S <br />Address, City, State, Zip � ( Q <br />1166 v1- <br />:Description of <br />'Event/ Purpose: <br />iCommunity Benent: <br />;Applicant Signature: <br />WI(St, <br />tt0� 5 '4—Gi <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 />Yes ❑ No <br />261 G �5 (L� <br />Even <br />-- (t Time <br />LI <br />-I Jo�rc��c--1 <br />J ct (4 Ci r H -r. I .t <br />C..OUO� <br />U <br />1 <br />CSC. Ile - <br />Cc (,1 ('11 Ct <br />le- <br />Cc(,1('11k tat l -C <br />t <br />l(�t -, <br />wy managers unite -NI -31i Email: donationrequestisantaaa. <br />norg <br />20 Civic Center Plaza <br />P.O. Box 1988 I Fax: (714) 8475984 <br />Santa Ana, CA 92702 <br />Donation Request #: I DR- <br />Eligibility <br />R- <br />Eligibility Met: f YES I NO 1'$$ <br />t--------- --NO - <br />I City Manager Signature —_ - <br />l Council Meeting Date: 12/18/18 <br />i Approved Amount: 1 $1,000- - <br />Date: <br />Revised 07/05!2017 <br />