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%. City of Santa Ana <br />Donation Request <br />Name: <br />WtGsr CC -vkJ" G cjj� Ut l <br />Address: <br />City, State, Zip: '�- <br />,t <br />Emali: {t <br />o'Lc:1 Gc`� --1 u('�CC�t� Ct0`Lti <br />City Manager's Office •- M-31 <br />20 Civic CentorPlaza <br />P.C. Box 1988 <br />Santa Ana, CA 92702 <br />(714) 6476200 <br />Title: C.i uc) <br />rt 42 <br />Phone: <br />Pax; <br />Name: f f / \^ <br />to -btilli rJ�.YF Cg4iCttE <br />Tax - Exempt Status: is your organization a (ion•profit or public tax - exempt organization as Select One: ('Yes No <br />defined under Section 601(c)(3) of the Internal Revenue Code? <br />If No, you will only quality for a credt for 04,-related costs for your request (La, permit fees. <br />staff time, rental rates for facilities or equipment, etc.). Costs for City services vary and if It Yss, 7 <br />approved, credit may or may not cover full cost of requested City services, Tax 10 #: (; - ;LS ,r✓°� <br />City Services Credit $ Date Needed: C5 —__ <br />Amount Requested: ->i U. i4 MayorlCounclimember: Please Choose From the List Below <br />Direct payment Amount Event pate: , <br />Requested: fjCo - r/ - 7� 1 Event Time; c <br />Event Location: z r f C. "t O ,,.r `� J�, l 1• 4 <br />Address, City, State, Zip <br />Description of <br />Event Purpose: <br />Community Benefit: <br />Applicant Signature; <br />i <br />