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City of Santa ulna <br />Donation Request <br />Name: Johnathan Hernandez <br />Address: '1310 E. Edinger Ave. Suite E. <br />,City, State, zip: Santa Ana, CA, 92705 <br />santanaunidosboxingc lub@gmail.com <br />Name: (Santa Ana Unidos Boxing Club <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: Executive Director <br />(Phone: 1626-474 -3067 <br />Fax: <br />Tax- 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? ( ✓ Yes No <br />Itf No, you will only qualify for a credit for City - related costs for your request (i.e. permit fees, - - -- - <br />staff tirne, rental rates for facilities or equipment, etc.). Costs for City services vary and if if Yes' X <br />lapproved, credit may or may not cover full cost of requested City services. ax ID #: 'l 47-5211563 <br />Ctty ervS ices Credit <br />(Amount Requested: $ Date Needed: (Mayor /Coumdlmembm: Sarmiento <br />(Direct Payment Amount nnp�nr1 1 - -_- Event Time: - -- - - - - - - <br />Requested: <br />$ 1 1000 Vv (Event Date: <br />(Event Location: 1 1810 E. Edinger Ave. Suite E. <br />Address city, stare, zn Santa Ana, CA 92705 <br />!Description of Jo raise awareness and to encourage families to participate in our program. <br />Event i Purpose: <br />Your contribution helps us keep our doors open and serve more youth. <br />!Community Benefit: <br />I <br />Applicant Signature: , 1�' t, � -'t ' F' uo' t t e V" Date: I6 -10 -16 <br />Mall: City Manager's Office -M31 iEmaiC donationrequost@santa-ana.org <br />20 Civic Center Plaza 1 Pax: (714) 647.6954 <br />P.O. Box 1988 <br />Santa Ana, CA 92702 <br />Donation Request V7 DR - Council Mooring Unto: _- <br />Ru'�+renc <br />V on atl,eht,d OPVn <br />Eligibility NreT, YES I NO Approved Arnoun4: <br />City rdianager Signahvc: ! , Pate. <br />Revised 11/16/2015 <br />F�4FI RIT-d <br />