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DocuSIgn Envelope ID: B9897EA3-FA97-4820-BE16-377FBA3408DC <br />1 City of Santa Ana 0 Donation Request <br />I <br />iName: Mamie Funahashi Title: ICFO <br />(Address: 1000 N. Alameda Street, Suite 240 <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 />,�ity, state, zip: Los Angeles, CA 90012 'phone: 1213-346-3200 <br />Email: mfunahashi@CommunityPartners.org IF= 1213 -808 -16,66 - <br />[Name: <br />I <br />Community Partners <br />Tax -Exempt Status: Is your organization a non-profit or public tax-exempt organization as <br />leflned under Section 501(c)(3) of the Internal Revenue Code? <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 />ipproved, credit may or may not cover full cost of requested City services. <br />Select One; <br />Yes <br />Z <br />If Yes, <br />Address, City, State, Zip <br />Tax ID 4: <br />19F5-4302067 <br />City Services Credit Date Needed: Sept. 20 Mayor/Counclimember: Rayne <br />Amount Requested: <br />Direct Payment Amount irl 0/29 <br />Requested: �$1500 FEen ',Event <br />Time: 17pm <br />---------- <br />El No <br />(Event t Location; <br />I To be determined in collaboration with Councilman Reyna and community <br />Address, City, State, Zip <br />oroanizations based in Ward 5. <br />Description of <br />To support Media Arts Santa Ana (MASA) in the 7th CIC Film Fiesta and provide <br />Event/ Purpose: <br />free public screenings in Ward 5. Media Arts Santa Ana (MASA) is a <br />ficPmIIv_Qr%nnQnrar1 nmiarf of r.nminniinifte PnrtnorQ n nnn-nirrifif <br />The Film Fiesta's free family screenings in Ward 5 will promote community <br />Community Benefit: <br />awareness & participation in cultural spaces, community orgs, schools, parks, <br />ature: <br />Applicant Signature: '19n <br />(Date. 9/2/2016 <br />OFW8CD842F468... <br />Mail: City Manager's Office - M-31 <br />20 Civic Center Plaza <br />P.O. Box 1988 <br />Santa Ana, CA 92702 <br />Donation Request DR <br />Rarkr'nVo 9 on mhWd npvs <br />Eligibility Met: t YES I NO <br />City Manager Signature: <br />Email: donationrequest@santaana.org <br />Fax: (714) 647-6954 <br />-_ - ------- -_ <br />Council Meeting Date: <br />Approved Am?unt: <br />Date: <br />EXHIBIT 1 <br />Revised 11116/2015 <br />