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C) <br />City Manager's Office- M-31 <br />i City Of Santa Ana 20 Civic Center Plaza <br />fii Donation Request P.O. Box 1988 <br />-p' Santa Ana, CA 92702 <br />(714) 647-5200 <br />';Name: Ginelle Hardy <br />Address: 822 S. Van Ness Ave. <br />,city, State, zip: Santa Ana, CA 92701 <br />Email: ginelleann@gmail.com <br />Phone• 714-905-6951 <br />Fax; — <br />(Nama: Heninger Park Neighborhood Association <br />Tax -Exempt Status: Is your organization anon -profit or public tax-exempt organization as ISelect One: <br />'d'defined under Section 501(:)(3) of the Internal Revenue Code? Yes <br />If No, you will only qualify fora credit for City -related costs for your request (i.e. permit fees, -"- <br />'staff time, rental rates forfacrtlities orequipment, ets).Costs for City services vary and If iif Yes, j <br />;approved, ctedit may or may not cover hill cost of requested City services. Irax ID M i 20-8756660 <br />i I i <br />Fiscal Sponsor: Charitable Ventures of OC <br />(City Services Credit <br />Amount Requested: i$-i-,$f5�i'8�' (Date Needed: June 22, 2017 (Mayor/Counciimember, Michele Martinez <br />'Direct Payment Amount I <br />Event Date: Event Time: <br />!Requested: $320.00 July 22, 2017 j 11:00 am - 3:00 pm <br />_ _- _ <br />!Event Location: <br />Addross, City, Stafe, Zip 700 block of South Ross Street <br />i , <br />;Description of , Heninger Park Neighborhood Summer Street Fair <br />Event/ Purpose: "An afternoon to meet neighbors and make new friends" <br />Community Benefit: An event to celebrate the neighborhood - not a fund raiser <br />Applicant Signature: g,�... ' _. _ _.... Date:.... .June 13, 2017 <br />a a m <br />Mall: City Manager's Office -M-31 Email: donationrequest@santa-ana.org <br />20 Civic Center Plaza Fax: (714) 647.6964 !. <br />P.O. Box 1988 <br />Santa Ana, CA 92702 <br />I <br />Donation RCque$R 8:. _. DR <br />Eligibility Met: YES I NO YES <br />City Manager Signeture: <br />Council Meeting Date: <br />Approved Fvnount <br />Date: <br />August 1, 2017 <br />$320 <br />Revised 01/05/2017 <br />