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({+' City Manager's Office— M-31 <br />:> City of Santa Ana 20 CIVIC Center Plaza <br />Donation Request P.O. Box 1988 <br />1+,,, Santa Ana, CA 92702 <br />__ (714) 647.5200 <br />INama: <br />(Address: - <br />Icily, State, Zip: <br />Danny Garza <br />3101 W Cubbon St <br />Santa Ana, CA 92704 <br />adxgarza@yahoo.com <br />ttla: <br />Phone: 1714-206-9084 <br />Fax: <br />Nama: The American Cancer Society <br />lax -Exempt Status: Is your organization a non-profit or public tax-exempt organization as elect One: <br />defined under Section 501(c)(3) of the Internal Revenue Code? <br />If No, you will only qualify for a credit for City-rclatod costs for your request (i.e. permit fees, Yes, �rq <br />staff time, rental rates for facilities or equipment, eta). Costs for City services vary and If If <br />approved, credit may or may not cover full cost of requested City services. ax ID #, <br />1-7 Yes L1 No <br />13-1788491 <br />City Services Credit <br />mount Requested: <br />Date Needed: <br />Mayor/Councilmember: <br />Tinajero <br />(Direct Payment Amount <br />Requested: <br />3rJ®O.00 <br />�EventDa4e <br />�04-23-2016 <br />--�---r--`------ <br />Event Time: <br />------ ....... <br />E12OO pY71 <br />Event Location: <br />a. [a Ana College <br />Adarass. City, Stato, Zlp <br />1539 W 17th Street <br />Santa Ana, CA 92706 <br />The American Cancer Society Relay for Life event is a life changing experience that gives everyone to Celebrate the lives of <br />Description of <br />people who have battled cancer, romog&wed loved ones lost, and "Fight Back" against the disease. Funds raised go to <br />Event / Purpose; <br />research, transportation to and rt9in'i"Ireatryll <br />their to <br />ape Lodge facilities to provide a free & comfortable place for patients and <br />caregivers stay eJrytl'�iysaEn stay focused1an <br />getting well. <br />Cancer has touched so gtiy sa/dplc in our cmm�lunf and the Relay for Life event is so inspiring, uplifting, and is a great way to help flight <br />Benefit: this disease. The Aisle can inner Society pmvldo � hotmallon, programs, and services that are available to patients and caregivers. This <br />Is also a great opper pity a to our brave fighters nd caregivers know that they are not alone, they can get educational resources to help <br />them on their Ignnln, , l� y can n1oct other fig Itt9a, and caregivers. <br />(Applicant Signature: �. (Date: 104-18-2016 <br />Return completed fotrm via: <br />Email: donationrequest@santa-ana.org <br />Mail: City Manager's Office—M•31 ( <br />20 Civic Center Plaza Fax: (714) 647-6954 <br />P.O. Box 1988 <br />Santa Ana, CA 92702 <br />Donation Request <br />Eligibility Met: <br />City Manager Signature: <br />1♦7;t <br />Council Meeting Date: <br />YES I NO Approved Amount; <br />Date: <br />Revised 11/16/2015 <br />