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City of Santa Ana <br />Donation Request <br />Woo <br />City Manager's Office– M-31 <br />20 Civic Center Plaza <br />P.O. Box 1988 <br />Santa Ana, CA 92702 <br />(714) 647-5200 <br />President/Chair <br />Melrose: 12234 North Pacific Avenue <br />Cit, state, zip: Santa Ana, CA 92706 Phone: F714 -8i5-8925 <br />by@yahoo.com <br />Name: jArtesia Pilar Neighborhood Association (APNA)/Charitable—Ventures of Orange County <br />Tax -Exempt Status: Is your organization a non-profit or public tax-exempt organization as <br />oiecB t pne; <br />Iefined under Section 501(c)(3) of the Internal Revenue Code? <br />Yes No <br />® <br />If Na, you will only qualify fore crack for City -related costs for your request (i.e. permit fees, <br />If Yes <br />;tall time,. rental rates for facilities or equipment, etc.). Costs for Ctty servicas vary and if <br />208756660 <br />ipproved, credit may or may not cover full cost of requested City services. <br />4 ax ID #: <br />Services Credit <br />unt Requested; <br />ct Payment Amount <br />(Event Location: <br />(Address, CiV State, Zip <br />ption of <br />I Purpose: <br />Benefit: <br />Needed: I. kw <br />1,000 jEvent oate: 1 12/30/17 (Event Time: <br />10 AM to 5:OOPM <br />EI Salvador Park & Recreation Center 1825 W Civic Center or; Santa Ana, California 92703 <br />w,xnom <br />Community involvement of youth and residents that builds strong healthy <br />communities thrive. <br />{Applicant Signature, <br />I <br />Po. x.1-1 <br />Reftirr�cnni iete'd r�i but -- �r. <br />Mali: City Manager's offico–M-31 <br />20 Civic Center Plaza <br />P.O. Box 1988 <br />Santa Ana, CA 92702 <br />Donation Request #: DR_ <br />Eligibility Met: <br />City Manager Signature; <br />Email: donationrequest@santa-ana.org <br />Fax: (714)647-6984 <br />j Council Meeting Date- <br />? Approved Amount: <br />Date: <br />EXHIBIT 10 <br />29A-13 <br />�\Uct .1( 201 <br />Revised 11116/2015 <br />