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City of Santa Ana <br />j" Donation Request <br />City Manager's Office— M-31 <br />20 Civic Center Plata <br />P.O. Box 1988 <br />Santa Ana, CA 92702 <br />(799) 047-5200 <br />t a <br />a <br />Direct Payment Amount <br />;Requested: <br />Name: <br />. KENNEY AGUILAR <br />Title: POLICE OFFICER/DIRECTOR <br />Address: <br />2627 W. McFADDEN AVE. <br />!Address, City, State, zip p <br />city, state, zip: <br />SANTA ANA, CA 92704 <br />phone: (714) 647-6591 <br />jEmali: <br />',KAguilar@santa-ana.org _..... __.., <br />Fax:. (714)..835-2289 , <br />Name: LORANGE COUNTY COMMUNITY FOUNDATION/ SAPAAL <br />defined <br />uncle Status: Is your organization a al Revenue <br />or -public tax-exempt organization as select One., <br />deOned under Section 501(c)(3) of the Internal Revenue Cotle7 �,. � Yes ❑ No <br />If No, you will only qualify for a credit for City-rela led costs for your request 0.e, permit fees, If Yes, <br />staff time, rental rates for facilities or equipment,etc.).Costs for City services very and if 3�.i_/13isi78 <br />approved, credit may or may not cover full cost of requested City services. Tax I6 #: 3J l�•,JJ // Q (( <br />Fiscal Sponsor <br />'City Services Credit <br />'Amount Requested: <br />Rp•Do Data Needed: }JUNE 2017 �Mayar/Cnunalimombor: '.Ullegea <br />Direct Payment Amount <br />;Requested: <br />,$55®®•00 Event Date: CONTI NUOUi Event Threat CONTINUOUS <br />'iEvent Locafion: <br />1'.2627 W. MCFADDEN AVE., SANTA ANA, CA 92704 <br />!Address, City, State, zip p <br />Supplemental Santa Ana Police Athletic & Activity League program service <br />Description of <br />.,;.Event/ <br />Purpose: <br />;delivery. <br />Direct service delivery of school, art, and program project supplies to <br />community Benefit: <br />:,approximately 200 at -risk Santa Ana youth. <br />.,Applicant Signature: <br />Date: 6/5/201.7 _ <br />8 0 i <br />,Mall; City Manager's Office— W21i Email: donationrequest@santa-ana.org <br />20 Civic Center Plaza Fax: (714) 647-5954 j <br />P.O. Sox %980'. <br />Santa Ana, CA 92702 <br />t ar ,Eornrg' ""' <br />_ <br />cv. -vcmiEm r'� JUNE 20, 2017 <br />,:,.,ry int <br />o YES „, I a,„c„.,t, $500 <br />Revised 01/0612017 <br />2MAi=21 <br />