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Name: <br />Address; <br />101ty, Mate, Zip: <br />NoMa: <br />"fax-EXetnpt Stems; Is year organization a non-profit cr public tax-exempt <br />Wined under Sectlorr 501 (c)(3) of the Internal Revenue Code? <br />City Manager's office _ Ni -31 <br />20 Civic Center plaza <br />P.0, Box 190 <br />Santa Ana, CA 92702 <br />(714) 647-5200 <br />I itle. _....._•_— <br />k5I !- <br />arc <br />IF= F <br />as iSel ct one. <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 />approved, credit may or may not cover hall cost of requested City services. <br />Yes No <br />Donation Requ t ;�; OR - <br />�r <br />Council Meeldnq Date: <br />___....._... __..____._..._,_..,_..............................._. ... _..... _.. <br />I <br />Eliglbifity Met, YES P NO ; Approvod Amount: <br />Clty Manager ignatum: T1ate9 <br />Revisers 0111 =17 <br />