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City of Santa Ans� <br />Donation Request <br />Address; _ / ,!�i XXL. - i . <br />;City, Scuta, ZIP: I� �nAifl, Art&- , <br />Nama; <br />I <br />t Edi.. <br />17 V s 1phone: p_ <br />____ <br />np8 taros: is your organization a nun -profit or public tax-exempt arg ilon as � ct Ot <br />Ider Section 501(c)(3) of the internal Revenue Code? <br />will onlyquaBfy for a credit for City -related costs for your request (f.e, permit fees, �---'-- <br />rental rates for facilities or equipment, etc.). Costs for City services vary and if f Yes, <br />credit may or may not cover full cost of requested Ch y services. a% ID #: <br />iCityServices Credit <br />Amount Requested: i <br />joirect Payment Amount I / <br />jRequested: / fVUV <br />Event Location�j� <br />Address, Cfty, State Zip , r <br />Time: <br />City Manager's office - M-31 <br />20 Civic Center Plaza <br />P.O. Boz 1930 <br />Santa Ana, CA 92702 <br />(714) 647-5200 <br />Ilan of I p <br />Purpose: 0, &t&L rTQ,7t- lldi&t . <br />i <br />Benefit: <br />891 Il LK t <br />Mail: City Manager's Office — M-31 <br />20 Civic Center Plaza <br />P.O. Bax 1988 <br />Santa Ana, CA 92702 <br />M <br />Emall: donationrequest®aantaana.org <br />Pax: (714) 647.6954 <br />Donation Request #: IDR - <br />council fdoefing Date: <br />Eligibility Mat: YES 7 Np `^ Approved Amount: —_ <br />ro ., <br />City Manager Signatures I Date: <br />Revised 01A IMI7 <br />