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C <br />City of Santa Ana <br />Donation Request <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 />Name: <br />Ivan Coziahr �W `Title: Executive Director <br />Address: <br />800 North Main Street u <br />city, state, zip: <br />Santa Ana, CA 92701 <br />Phone: <br />714- 480 -2441 <br />IEmail: <br />— - <br />icoziahr @uci.edu <br />Fax: __714- <br />— <br />560 -0640 <br />e g. <br />Name: UC Irvine, Family Health Center -Santa Ana <br />Tax - Exempt Status: Is your organization a non - profit or public tax - exempt organization as <br />defined under Section 501(c)(3) of the Internal Revenue Code? <br />Select One: <br />Yes ❑ No <br />If No, you will only qualify for a credit for City - related costs for your request (i. e. permit fees, <br />staff time, rental rates for facilities or equipment, etc.), Costs for City services vary and if .,� <br />approved, credit may or may not cover full cost of requested City services <br />If Yes, <br />Tax ID #: <br />(� /) (� <br />V <br />952226406 <br />City Services Credit <br />mount Requested: I$3OO (Date Needed: l 12 /18/15 (Mayor /Councilmen bar: I Reyna <br />Direct Payment Amount 12/18/15 Event Time: <br />Requested: $ Event Date, 1O:OOam- 3:3OprYl <br />F nt Location: 800 North Main St, Santa Ana CA 92701 <br />ess, City, State, Zip <br />Description of UC Irvine, Family Health Center Nancy's Miracle Toy Giveaway 20th Anniversary <br />Event /Purpose: <br />For the past 19 years we have been able to collect new toys to over 4000 needy children for the City of <br />Community Benefit: Santa Ana and its surrounding communities (Newborns to -Teens) Thank you so much for your <br />Wsup rt <br />Mail: City Manager's Off ice —M -31 Email: donationrequest@santa-ana.org <br />20 Civic Center Plaza Fax: (714) 647.6964 <br />P.O. Box 1988 <br />Santa Ana, CA 92702 <br />Revised 11/16/2015 <br />