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City <br />Cit of Santa Ana <br />City Manager's Office -M-31 <br />20 Civic Center Plaza <br />"^ Donation Request <br />P.O. Box 1988 <br />Santa Ana, CA 92702 <br />-- <br />(714) 647.5200 <br />a <br />Name: IJackson Wright <br />development Associate <br />ddress: 128 E. Katella Suite 200 <br />City, State, Zip: (Orange CA 92867 �IPhone: <br />(714 - 408 - 9313 — <br />Emau: )acksonw@nwoc.org <br />Fax: <br />r�. <br />714 - 408 - 9863 <br />---— —-------- -- --- — <br />--- <br />------- — -- <br />Name: NewighborWorks Orange County <br />Tax -Exempt Status: Is your organization a non-profit or public tax-exempt organization as <br />defined under Secti501(c)(3) of the Internal Revenue Code? <br />elect one-- <br />FRI Yes ❑ No <br />ff No, you will only qualify for a credit for City -related costs for your request (i. e, permit fees, <br />rf Yas`--"`----_ <br />staff time, rental rates for facilities or equipment, etc.). Costs for City services vary and if <br />-approved, credit may or may not cover full cost of requested City services. <br />ex ID #:�95-3130152 <br />- - -- �-- <br />— -- <br />(City Services Credit <br />$500 Date Needed: <br />MayorlCouncfimember: <br />Benavides r <br />44mount Requested: <br />Direct Payment Amount <br />�Re nested: <br />—^ — <br />Event Date; ZiZ5iZ017 (Event Time: <br />— - <br />1OSfTI - 1pm <br />ent t.ncation: <br />r <br />1400 Block South Townsend St. Santa Ana 92704 <br />dress, City, State, Zip <br />*Event Summary and Community Benefit attached <br />Description of <br />Event l Purpose: <br />rEvent Surpmary and Community Benefit attached. <br />Community Benefit: <br />11/ <br />1 p <br />Applloan }gtgnafure <br />ate <br />I <br />— <br />i.. <br />- <br />Mari: City Manager's Off M-3 (Email: donationrequest®santa•ana.org <br />,c <br />20 Civic Center PI a f Fax: '7141647,6914 <br />P.O. Box 1988 <br />Santa Ana, CA 92702 <br />e <br />Donation Request #: DR - <br />Reference # an a!I related DPVs Council Meeting Date. <br />_ <br />Eligibility Met YES I NO Approved Amount <br />-_....i-_ <br />_._- <br />City Manager Signature Date <br />... ____. .. ....... ._-..__. <br />J <br />Revised 01/0512017 <br />