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.z City of Santa Ana <br />Donation Request <br />City Managers Office— M-31 <br />20 Civic Center Plaza <br />P.O. Box 1966 <br />Santa Arta, CA 92702 <br />(724) 647-5200 <br />Contact • <br />.Name: Mary H. Lara Title: Director _..__. <br />address: T.O. Box 25541 <br />;city, state, 7Ip: Santa Arca, CA 92799 Phone: {714) 336.3361 <br />maii: mary.laraB13@yahoo.com Fax: <br />Organization lnfqrrnkion� <br />IName- TIDO Boxing Club <br />defined under Section syour <br />C 3 a#the Internal Revenue Cod s <br />Tax -Exempt is � �{o arnziitian a non-profit or ober' tax-exempt organization as Seloct One: ®�,es <br />El <br />No , <br />If No, you wN only qualify for a credit for City -related costs for your request # e, permit fees, 9fYes, <br />,staff time, rental rates for facilities or equipment, etc.).Costs for City sawkes vary and rf *� <br />�aipproved, credit stay or may not cover full cost of requested City services. Tax ID # `] � <br />L) na:tie.. <br />pity services Credit <br />Amount Requested: Date Needed: 3/15/17 MayoriCouncifmamber. Sarmiento <br />Direct Payment Amount <br />RggEwsted: s500.00 Event Date: Event Time. <br />R@quoste <br />!Event Location: Jerome Center, 726 S. Center, Santa Ana, CA 92704 <br />lAddress, City, Stare, Z'ip <br />c <br />Description of For ongoing expenses, i.e. equipment, supplies, travel to competitions. <br />jEvent l Purpose: <br />770 serves as a gang -prevention program in one of the most troubled areas of <br />Community 88nefit: the City. We offer at -Tisk youths a safe and structured place to meet after school. <br />Applicant 5ia3nature: <br />Date:&7 <br />ti <br />Mail: City Manager's office—M41 <br />20 Civic Center Plaza <br />P.O. Box 1988 <br />Santa Ana, CA 92702 <br />Donation Raquo,-.t th DR - <br />Ellgibflity Met: <br />City Monagerairgnalure: <br />Email: donationrequest@santa-ana.org <br />Fax: (714) 847-6954 <br />I <br />Council maoting nate: <br />Approver) Amount: <br />Gate: QJV� <br />Revised 11116f20is <br />