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State of California <br />Financial Information System for California (FI$Cal) FI$Cal <br />GOVERNMENT AGENCY TAXPAYER ID FORM <br />2000 Evergreen Street, Suite 215 Financial Information System for California <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 <br />Pity of Santa Ana <br />Government <br />Agency Name <br />Remit -To <br />.O. Box 1974 M-13 <br />Address (Street <br />or PO Box) <br />City <br />Panta Ana <br />State PAA Zip Cade+4 2702-19iJ <br />Government Type: <br />❑✓ City ❑ County <br />Federal <br />Special District Federal <br />❑ ❑ <br />Employer <br />Identification <br />❑ Other (Specify) <br />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 Complete <br />Name Address <br />Dept/Division/Unit <br />Name <br />Dept/Division/Unit <br />Name <br />Complete <br />Address <br />Complete <br />Address <br />Dept/Division/Unit Complete <br />NameI i Address <br />Contact Person Peborah Sanchez Title JEcon. Dev. Specialist III <br />Phone number 14-565-2621 E-mail address sanchez@santa-ana.org <br />Signature <br />Date 22-24 <br />