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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 />IName. ---IJackson Wright F',I a. -Development <br />Associate <br />Address: <br />128 E. Katella Suite 200 <br />City, zip: <br />--[Phone. <br />Orange CA 92867 <br />4 - �Oli - 9313 <br />[Emall: )acksonw@nwoc.org <br />408 - <br />[Nana: FNewl�ghbofflorks Orange County <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 />�IS�eI'e-ct One: <br />r <br />yes ❑ No <br />If No, you will only qualify fora credit for City -related costs for your request (i.e. permit fees, <br />staff time, rental rates tortacifitlea or equipment, etc.).Costs for Cityservices vary and if <br />Ify <br />I Yes, <br />approved, credit may or may not cover full cost of requested City services. <br />�ax ID #: <br />195-3130152 <br />11r. MIM. <br />Ity Services <br />500 DataFm Credit Needed: <br />� <br />y,,/C,,nilmember: <br />Tinalero <br />Requested: <br />F <br />Event Date: <br />I vent Time: <br />Dam - 1 pm— <br />Requested: <br />:Ve <br />Ver t L1111ticur: <br />r <br />00 Block South Townsend St. Santa Ana 92704 <br />Address, City, State, Zip <br />*Event Summary and Community Benefit attached <br />Description of <br />Event / Purpose: <br />Event Summary and Community Benefit attached. <br />CommunityBenefit: <br />�0 <br />Mail: City Manager's Office -M31 <br />Email: donationrequest@santa-ana.org <br />20 Civic Center Plaza <br />Fax: (714) 647-6954 <br />P.O. Box 1968 <br />Santa Ana, CA 92702 <br />Donation Request it. DR - Council Meeting Date: <br />------- ------ <br />--------- <br />li Eligibility Met: YES/ NO Approved Amount: <br />City Manager Signature:Date <br />Revised 01105/2017 <br />29A-3 <br />