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t ti City of Ana <br />Donation i <br />City Manager's Office — WI <br />20 Civic Center Plaza <br />P.O. Box 1988 <br />Santa Ana, CA 92702 <br />(714) 647.5200 <br />Name: <br />Felipe Guerrero <br />lae: <br />a: <br />President _ <br />ddress: <br />204 N. Susan Street <br />'Direct Payment Amount <br />Requested: <br />city, state, zip: <br />Santa Ana, CA 92703 <br />hone_ <br />Phone: <br />r_�- -- <br />(714) 265.2071 <br />Eman. <br />_ _ <br />godfnano @aol.com <br />Fa x: w <br />N a r e v <br />Name: Santa Anita Neighborhood Association <br />Movie night event intended to bring the community together and provide a fun <br />Description of <br />night of entertainment. <br />Tax - Exempt status: Is your organization a non - profit or public tax - exempt organization as <br />defined under Sectlon 501(c)(3) of the Internal Revenue Code? <br />Select One: <br />21 Yes No <br />ff <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, arc.). Costs for City services vary and if <br />'"" <br />If Yes, <br />` <br />[20-75660 <br />approved, credit mayor may not cover full cost of requested City services. <br />(fax ID #: <br />C7 GJ <br />Fiscal Sponsor: Charitable Ventures of Orange County Inc. <br />City Services Credit <br />;mount Requested: <br />$ 1 ,000 <br />Date Needod: <br />JUiy 21, 2017 <br />Mayor /Councilmember: <br />Tinajero <br />'Direct Payment Amount <br />Requested: <br />$ Event Date: <br />� <br />— <br />iJUii 21 2017 <br />y <br />iEEve'nt Time: <br />I <br />6:30 m <br />p <br />Event Location: <br />Santa Anita park <br />Address, City, State, zip <br />Movie night event intended to bring the community together and provide a fun <br />Description of <br />night of entertainment. <br />Event /Purpose: <br />Neighbors come out of their homes and get to know each other better. This event will be our <br />Community Benefit: <br />second annual, our event last year was very successful and attracted several hundred <br />participants. <br />�A hcant Si nature � ' � U � (�e�ri <br />Mail: City Manager's Office — M -31 <br />20 Civic Center Plaza <br />P.O. Box 1988 <br />Santa Ana, CA 92102 <br />Email: donationrequest @ santa- ana.org <br />Fax: (714) 647.6954 <br />Z "i {" Revised 01/05/20'17 <br />