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DocuSign Envelope ID: D0419EBA-AE42-4CAB-AF7D-59E5A27A7845 <br />state or uaiffornia <br />Financial Information System for California (FI$Cal) rI$CQ/ <br />GOVERNMENT AGENCY TAXPAYER ID FORM Finmxicl In(armouon System (or California <br />2000 Evergreen Street, Suite 215 <br />Sacramento, CA 95815 <br />www.fiscal.ca.gov <br />1-855-347-2250 <br />The principal purpose of the information provided is to establish the unique identification of the government entity. <br />Instructions: You may submit one form for the principal government agency and all subsidiaries sharing the same TIN. Subsidiaries with a <br />different TIN must submit a separate form. Fields bordered in red are required. Hover over fields to view help information. Please print the <br />form to sign prior to submittal. You may email the form to: vendors@fiscal.ca.gov, or fax it to (916) 576-5200, or mail it to the address above. <br />Principal isanta Ana <br />Government <br />Agency Name <br />Remit -To 120 Civic Center Plaza <br />Address (Street <br />or PO Box) <br />City Santa Ana State F57-] Zip Code+4 92701 <br />Government Type: ❑x City ❑ County Federal 956000-785 <br />Special District Federal Employer <br />❑ ❑ Identification <br />❑ Other (Specify) Number <br />(FEIN) <br />List other subsidiary Departments, Divisions or Units under your principal agency's jurisdiction who share the same <br />FEIN and receives payment from the State of California. <br />Dept/Division/Unit <br />Santa Ana Public Library <br />Complete <br />26 Civic Center Plaza, Santa Ana, (4 92701 <br />Name <br />I <br />Address <br />Dept/Division/Unit <br />Complete <br />Name <br />Address <br />Dept/Division/Unit <br />Complete <br />Name <br />Address <br />Dept/Division/Unit <br />Complete <br />Name <br />Address <br />Contact Person <br />IMaria Castro <br />Title <br />I senior Management Analyst <br />Phone number <br />714-647-5269 <br />E-mail address <br />mcastro5@santa-ana.org <br />Signature <br />'�� <br />rrEvian. <br />Date 1/9/2023 <br />Sh.nJ�u^g <br />l ----Y- <br />