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•u <br />City tl'PSalnta Ana <br />Donaffon Request <br />Clry Manager's Offico - M41 <br />20 Civic Confer PMn <br />P.O. sex 1980 <br />Santa Ana, CA 92702 <br />(714) &170200 <br />Name: RIO r � e_ <br />Addrosa; <br />City, State, rl p; l- I-- -•.-.- — lsd —(-°✓ --•— phone; ri ( c?J b �+���„ <br />Fax` <br />(1 <br />O <br />Donation Request <br />CNy Servioes Credh <br />;%untRequested: <br />Name: �^ <br />Birect Payrnant Amount <br />equesteo: <br />$ Event oats: O /.l 6 G AJ Event Time: e l - <br />Tax-6xempt5tatus: is your otprr Dona iron• profitorpubliotex- Exemptorganimiones <br />alined under Section S01(c)(3) of Ih� Intemel Revenue Code4 <br />a12CE0aa: <br />� Yea No <br />00, you W11 only qualily for a ota(& the City - related casts foryour request li.e• psrmlt fees, <br />stafftime, rental rates fdefecilldos 6 equipmen ;efm).Costs for City s9mYces vary and if <br />approved, craditmayofmaynotooNrrfull costofrequested CityserWees. <br />If YSa, <br />IY'ax in 0: <br />t-- <br />y�r7 <br />I 3-. t) <br />--d <br />A <br />Donation Request <br />CNy Servioes Credh <br />;%untRequested: <br />r r <br />�- -- 2r L, C( ``rf4f^r� -� <br />$ Bete Needad; // MayodCouncllmemhon 1 <br />Birect Payrnant Amount <br />equesteo: <br />$ Event oats: O /.l 6 G AJ Event Time: e l - <br />Event Location: IjI <br />A40re$q,ciy, state, ➢p <br />i1 a� (r w-,,- 07 6+ - <br />f <br />Description of i <br />Event Purpose: <br />�_'!'" `� /}"�' �' �e'� C IJj� /1•/>"l T �- ��s QS <br />�c.5 d/ <br />/�� <br />J <br />--d <br />A <br />'�- <br />Mail: Cite Mana0ars <br />nter Pima Office- N,.19 — �Email: donaU-nnrequast�santa.ana.org — —� <br />20 CIVIC Center Plea I Fax: (714) 647.0034 <br />P.O, nag 1900 <br />Banta Ana, CA 92702 <br />Donation Roquest#: ?t- CouneiV'MnoD�g Belle; . <br />1?e temcA�%on all relatedt5PVS ._._— .,_..._ '04/18/2017W___.— <br />d Amount $1,000 '. <br />...__ .....,. pYOVa <br />EugiBlliry mot r s r No YES A'p _ <br />City Manager 5iggre: gtu Bate <br />Revised 0110512D17 <br />,► • - <br />