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CltyManager's Office— M41 <br />,sh City of Santa Ana 20 Civic Center Plaza <br />Donation Request N-2018-222 P.O. Box 1988 <br />Santa Ana, CA 82702 <br />-- (714) 047-5200 <br />Contacto <br />Name: IPeter Mangosing ide: Chief Instructor <br />c dress: 118 W. Stevens Av. <br />uy, state, 2Ip: Santa Ana, Ca. 92707 Phone: 714-7.45-7801 <br />lEmalk itkksensei@te-kenjutsu-kan.com IFax: <br />IName: ITe-Kenjutsu-Kan Karate -Do Organization <br />opt Status: Is your organization a non-profit or public tax-exempt organization as <br />der Section 601(c)(3) of the Internal Revenue Code? <br />Wit only qualify fora credit for City -related costs for your request (l. a, permit fees, <br />rental rates for facilities or equipment, etc.). Costs for City services very and if <br />credit may or may not cover full cost of requested City services. <br />One: <br />Yes, <br />Ix ID #: <br />ZYes ❑ No <br />20-1371172 <br />Return completed form via: <br />Mail: City Manager's Office -M-31 Email: donationrequest@santa-ana.org <br />20 Civic Center Plaza Fax: (714) 847.8984 <br />P.O. Box 1988 <br />Santa Ana, CA 92702 <br />e DMayor/Couneilmembor. SoloroCity ServicesCredit o Needod: <br />[Amount Requested: <br />irect .0.0 EvenYDate: 11/11/1$ Event Time: <br />DequesaymentAmount <br />9:00am <br />Requested: ,C�© <br />City Manager Signature: <br />_ _ ate= <br />�T <br />Event Location: <br />Segerstrom I School <br />Address, City, State, Zip <br />2301 W. MacArthur Blvd. Santa Ana, Ca. <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 I Purpose: <br />4 -pack of paper towels. All donated goods go to the WisPlace a Shelter for Women in the City of Santa Ana. <br />The event benefits The WisePlace a shelter for women in Santa Ane 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 ladles of WisePlace. It also benefits our youth in teaching the Importance of community <br />68NIee. <br />Applicant Signature: <br />` <br />[Date: <br />Return completed form via: <br />Mail: City Manager's Office -M-31 Email: donationrequest@santa-ana.org <br />20 Civic Center Plaza Fax: (714) 847.8984 <br />P.O. Box 1988 <br />Santa Ana, CA 92702 <br />Revised 01/05/2097 <br />Donation Request M. DR- <br />Nefmzncv 9 on all related DPVa <br />Eligibility Met: YES I NO <br />Council Meeting Date: <br />YES Approved Amount: <br />11/20/1$ <br />$500 <br />City Manager Signature: <br />_ _ ate= <br />�T <br />Revised 01/05/2097 <br />