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/"'' City of Santa Ana <br />�{ Donation Request N-2019-018-01 <br />Contact Information <br />Name:C 1 Ln , I <br />Address:���i <br />City, State, ZIP: <br />C4 <br />4 <br />Email: <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 />Title: �) 1 6 i5 E. 1c; °t Ci f 'L, I <br />?acei dy /L/p t. -%'t f `C � IV <br />Phone: 71 Y 6Q( <br />Fax:/ I✓ G� <br />Organization Information <br />Name: 1 V r J 'Xe - \C I�.Ciip j C�(��'�fVtoC t� /I. AL/ it ��L4�'1�� 0 (-C _.... <br />Tax -Exempt Status* Is your organization a ran-proffiiFor JL bhc tax-exempt organizat n as Select One: ❑ V o 1 <br />defined under Section 501(c)(3) of the Internal Revenue ode? yes No if <br />If No, you will only qualify for a cracit for City -related costs for your request (i.e. permit fees. It yes, <br />stall time, rental rates for facilities or equipment, etc.)- Costs for City services vary and if <br />approver, credit may ormay not cover full cost ofrequested City services. Tax ID#: ¢ {, <br />City Services Credit ) Date Needed: � `i ;)`��' p+ layoriCounclimember: Pulic1O <br />Amount Requested: I� �} <br />Direct Payment Amount <br />Requested: $ Event Date: Event Time: �). <br />1 . - + - I G r� <br />Event Location: Kl t l S vl rY P S tJ/L S Q ./�j �C t t C� [ Ct f't tlt�l — J <br />Address, City. State, lip %) b C C ;,�-:. SG , n 1 �i S j 7. 2 Jl.�l �1c '1- <br />11! <br />LI 'r r c JC.�-' Pr 1 <br />Description of S t 2 G� (�t t C <br />Event Purpose:C <br />o U Q� � v � 1 C� (o � �-�i 116.I>/1 C i L K S <br />Gt,",c� r� :..,� L�{� Co ,,u <br />CommunityBenetit: >/ r <br />Applicant Signal �{—J - parr.. y <br />Mail: City Manager's Office – M-31 <br />20 Civic Center Plaza <br />P.O. Box 1988 <br />Santa Ana, CA 92702 <br />Emali: don ationrequest@santa-ana.org <br />Fax: (714) 647-6954 <br />Donation Request p: <br />DR <br />Council Meeting Cater ...... <br />...12(18(18 <br />Eligibility Met: <br />YES t NO YES <br />Approved Amount: <br />$1,000 <br />t;ity;:&annger Signature: <br />�� NNA—� <br />D'1t <br />1.10 , 201"\ <br />Revised 01/0512017 <br />EXHIBIT 1 <br />