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City Manager's Office - M -39 <br />(9) City of Santa Ana 20 Civic Center Plaza <br />Donation Request P:O, Box 1988 <br />Santa Ana, CA 92702 <br />(714) 647 -5200 <br />f �► <br />Name: .- <br />Tax- Exempt Status: Is your organization a non - profit or public tax- exempt organization as I Select One: <br />ietned under Section 501(c)(3) of the Internal Revenue Code? ❑ Yes ® No <br />It No, you will only qualify for a credit for City- ra/atad costs for your request (i e, permit fees, 'Bf Yes, <br />- <br />otaff Pima, rental rates for facilities or equipment, etc.). Costs for City services very and if <br />ippmvad, credit may or may not cover full cost of requested City services. Tax BD M <br />lty Services Credit i Q 9!� <br />mount Requested: 1 $342.32 Date Needed: V, 204 'Mayor /Counclimembar ! Please Choose From the Lost Below <br />Direct Payment Amount �` _ Event Date: Event Time:Requested: ' ,. .. -... <br />�iEvent Lonflon: <br />jAddress, City State, Zip <br />[Description of .Q.+ .... _. -__.. <br />Event /Purpose: <br />Mail: City Manager's Office -M -81 ! Email: donationrequest&anta- ana.org <br />20 Civic Center Plaza !. Fax; (714) 647 -6954 <br />P.O. Box 1988 <br />Santa Ana, CA 82702 <br />Donation Request ft: ..... DR - <br />62ePm ilpGa 4f qn ail rclaftitt d3!'41:: I <br />Eligibility Met: ` YES / NO <br />City Manager Signature: <br />Council Meeting Date. <br />App'ravou Amount: <br />Dam <br />IT <br />Revised 1111612015 <br />