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City Manager's Office - M-31 <br />City of Santa Ana 20 Civic Center Plaza <br />Donation Request P.C. Box 1988 <br />L. Santa Ana, CA 92702 <br />(714) 647.5200 <br />Information <br />71t1a: <br />Name: 1�.,/i Gl.!L:C 1.1� `�t C jf'Y1`I l✓l l S-��� <br />-..—._.I_.. `....��AP <br />n,�}/._..�.__-._..-._.._�—__ <br />—' <br />Address_ <br />-- -- <br />City, State, Zip: <br />_ S a✓�.E-G, ��,�__-��!__�--�o � I � �� �1�& 1.—__ <br />_._- __ .., _� <br />(..—J._6(t V rt7(i�"�(' <br />5 <br />Organization Informati. <br />UC— <br />Tax -Exempt Status: Is your organization a non-profit or public tax-exempt organization as <br />defined under Section 501(c)(3) of the Internal Revenue Code? <br />Select Ono: <br />� <br />r—,r{ <br />I N I Yea No <br />L_I <br />If No, you will only qualify for a credit for City -related costs for your request (i.e. permit fees, <br />staff time, rental rates for facilities or equipment, etc).Costs for City services vary and if <br />credit may or may not cover full cost of City <br />��.� le I' <br />if Y®s, <br />Tax ID N;o-- <br />approved, requested services. <br />!Donation •. <br />City Services Credit <br />AmoOnt Requested: <br />�I�-------- r <br />id Date Needed: "r Ma or/Councilmember. 'BBeBwdee `' t <br />I" s "" ('- <br />Direct Payment Amount <br />Requested: <br />^ <br />I$ Event Date: (Event Time: Ij CI,YVI •_ `'L -..,(,dry -I <br />U <br />nt Location:ess, <br />FVe <br />--� <br />Clty, 3lalo, Zip <br />CyCtifvt-,�l /l 1,\�l ��J� �i�Z.�yo <br />Dosorlpilon of•t-U,L+ <br />Gkct7, cC..DAAC%o 4r'�7-t�"�-..C>�"� <br />Event/Purpose: <br />V N-rVl7C�c�.+YS 'a-'�-V- `�` Y^) G(?/" C_ y1..JJl��G-1 I <br />Community Benefit: <br />�rt�rv' �7iti Ftp(e �(PQ VLQ,tCJ'_A'�ra.�6 �^ �• <br />�Appticant Signature; -mm I <br />/} - <br />%�� r�',�n - Date5 <br />Maih City Manager's Office-M-31Email: donationrequest@santa-ana.org —� <br />20 Civic Center Plaza Fax: (714) 647.6954 , <br />P.O, Box 1980 <br />Santa Ana, CA 92702 <br />Donadon Request a DR • r ,tet „, 1-y - <br />r{a natio ll all 5t 4; d0nu _ Council Meeting Dato -- <br />__ _. - <br />`__._ <br />k"Ilglbllity Met YENO Approved Amount �i <br />City Managor Signature: Data: <br />Revised 01/05/2017 <br />