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City of Santa Ana <br />Donation Request <br />City Manager's Office — Nl <br />20 Clain Center Plaza <br />P.O, Box 1488 <br />Santa Ana, CA 92702 <br />(714) 647.6200 <br />r— <br />Address: <br />t 'L�,,g <br />•'"\• (�� �,(( <br />Cny State, Zip <br />���,.. �',.w•.v.�F t <br />�. 1'i . <br />L-��t„� .Phone: L �I L(1 <br />Name: C_' Foundation <br />fax <br />Exempk Status Is your organization a non-profit or pub <br />lic tax -'exempt organization as �Select One; / <br />tellned under Sectlon 501(0)(3) of the Intornal Ravenua Cade? 1 Yes> No <br />Itsff time, rental rates for facilities or equipment, eta). Costs for City sere ccs vary and f fees, <br />Y Y qualify Y Y q i c FTayx <br />es, <br />'if ry <br />ippro led, credit may or may not cover full cost of requested City servicea. ID #: <br />City Services Credit $ Date Needed ` Ma or/Councllmember. ,- <br />rnountRequested. y. <br />lRoquosted: nt Amount $ IEvent ate: �""')n'-� ..01 [Event Time: <br />IRaquosted IJ �, Coca _( G� r I 1 <br />._..._ .._...,._.._„__....w„_.. <br />'. Event Location: <br />Address City, state y <br />14 <br />h,�a <br />Description of '^ t4%u�h CnH"-L� <br />Event/Purpose: (r tt <br />CAVIu / <br />�::IQVt?f W�^�.vr I' (lYo�rUwS <br />y <br />Cammunit Benefit: 1 V <br />Applicant <br />City Manager's Office -- M-31 <br />20 Civic Center Plaza <br />PA, Box 1988 <br />Santa Ana, CA 92702 <br />If an a{, <br />YES•r NO YES,._ <br />City Manager Signature: <br />Email: donationrequest@santa-ana.org <br />Fax: (714) 6486964 <br />I t <br />WeY,t�l, r <br />, ..,.d�_..ar ..... F '�u4V'5.5b:1 <br />Az <br />Council Maatin -Data <br />5 Ih August 1 2017 <br />Approved Amount $1,500 <br />..... -- <br />Data: _ ._.._.._. _.._.__ <br />--,evisod 01/05120 <br />017 <br />