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City of Santa Ana <br />Donation Request <br />City Manager's Office — M-31 <br />20 Civic Center Plaza <br />P,O. Box 1988 <br />Santa Anar CA 92702 <br />(714) 647-5200 <br />Mama: Mary H. Lara Title, Director <br />�ddress: P.O. Box 28541 <br />Pity, sty, Zip: ` Santa Ana, CA 92799 Phone: (714) 336-3361 <br />Email: mary.iara8I3 a@yahoo,com 'Fax: <br />• orM <br />jName: TIDO Boxing Club <br />i Tax -Exempt Status: Is your organization a non-profit or public tax-exempt organization asgleet one: <br />defined defined unInternal <br />der Section 509 (c)(3) of the Revenue Code? Ij Yes ® No <br />If No, you will on qualify for a credit for C' related costs for our <br />Y only q �Y +tY Y request {i.e. permit fees, If Yes, ~ <br />staff time, rental rates for facilities or equipment, etc.). Costs for CRy services vary andif /'1(� (y <br />lapproved, credit may armay rratcover fullcost afrequestedGr7yservices, Tax ID #: �1() �J <br />3nna#ie <br />;City Services Credit <br />Amount Requested: � Date Needed: 3/15/17 MayorlCouncilmembor. Sarmiento <br />iDirect Payment Amount <br />!Requested: 500.0® Event Date: Event lime: <br />!Event Location: Jerome Center, 726 S. Center, Santa Ana, CA 92704 <br />Address, City, State, lip <br />i <br />j®escriptican of <br />For ongoing expenses, i.e. equipment, supplies, travel to competitions.' <br />11 Event l Purpose: <br />!TKO serves as a gang -prevention program in one of the most troubled areas of <br />cornrnunity Benefit: the City. We offer at -risk youths a safe and structured place to meet after school. <br />[Applicant Signature: r C Date <br />Mail: City <br />M_.. <br />Manager's Office —M-31 <br />20 Olvic Center Plaza <br />P.O. Box 1988 <br />Santa Ana, CA 82702 <br />Donation Roquast t;•: DR - <br />Ugibilityy Met: OS <br />NO <br />CKV ManagorSignature: <br />Email: donationrequest nta-ana.org <br />Fax: (714) 847-6984 <br />i <br />Council Meeting !?ata':: <br />Approved Amount: <br />(Jett:: �I I <br />Revised 19116/2095 <br />