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11 <br />40" Kjo.. <br />t3 s . �A�5 K <br />".: <br />i -0 lfS' <br />Q I <br />i2 Y <br />.V1 <br />C►tyNlan a`a Qtca <br />. d,�ii�a i�l?a <br />liY <br />2G.C(viceri%(e <br />_ <br />Donation Request <br />- <br />n ` �M�:/�►�r��j��p T <br />5arrta �rr�i' Lr�G���i 514 <br />Name. NatiAluacado. _,, . <br />Title, ..., . xecu#ive D'irectair <br />Addrfts: 1920 E. 17th Suite 202 <br />City, state, zip: Santa Anna Ca. 92705 <br />Phone: 714287-7747 <br />nati n services.or <br />email: � � g <br />'Fox: <br />name, Natis House] DBA Nuetral Ground <br />ax -Exempt Status,. Status: is your organization a non-profit or public text exenipt organization as <br />defined "e7 <br />Select One: <br />% Yes No <br />under Section 501(c)(3) of the Internal Revenue <br />-1l No, you %W# only qualify for a credit for City -related costs for yourrequest fie, pormif fees, <br />if Pete, <br />staff time. rental rates for feciflties or equipment, a(m). Caste for City services very and if <br />45.4041042 <br />approved, credit may or may not cover full cost of requested City services. <br />'Tax to #; <br />Dr. Min. Tvi <br />City Services Credit $ 1,000.0 Date hleeded; 03!25/2017 :Mayor/Couneitmember. Solorio <br />Amount Requested: <br />Direct Payment Amount .$ 1,{)[ 0.0 Event Date: every Sat Event Timei6 <br />Requested: <br />,00plim <br />1020 F. 17TH St. Santa Arra Ca. 92706 <br />Event location: <br />Address, CO. State, Zip <br />Youth gathering, bringing youth together from throughout Sante Anis. <br />Description of Youth are provided with valuable life skills information by positive role models. <br />Event l Purpose: <br />Sy bring our youth together into a neutral place, our youth will be able to meet <br />community berudit: others which will in turn break down the barriers that we have in our city: <br />"Youth 11rogram services include mentoring, life skills, and community resources. <br />Iipplicant. Signature: Date: /3/2017 .. . <br />Return r Y Y Y <br />.Mail: City. MAanagee.9 office" M-31 email: donationrequest@santa•ano.org <br />20.Cmc.Center Plan Fax: (714) 647-6964 <br />P.O. Box 1988 <br />Santa Ane, CA 92702 <br />