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City of Santa Ana <br />City Manager's Office - M-31 <br />Center <br />20 Civic Plaza <br />Donation Request <br />P.O. Box 1988 <br />Santa Ana, CA 92702 <br />- <br />(714) 647-5200 <br />• s a <br />_—`-----'_-----_�-_---_'-`---^-IT121e] <br />Mame: _ (Tish Leon <br />I President of 0=M= Neor" Ps <br />'ghtsocieGon <br />i-� <br />TA1 ddreas: J1700 W. 3rd St A208 <br />Fity,state zip: Santa Ana 92701 -~•4�-_-�_ --------.__._._ -h�one: <br />lip <br />--1�7--1-4-4-0-1-8-3-1-2 i <br />Fmau: �lety.leon1951@gmail.com <br />no .. <br />rName: Charitable Ventures of Grange County <br />Tax -Exempt Status: Is your organization a non-profit or public tax-exempt organization as (- <br />.Select One: <br />,defined under Section 501(c)(3) of the Internal Revenue Code? i <br />- <br />Z Yes FTN, <br />If No, you will only quality fora credit for City -elated costs for your request (i.e. permit fees, r`—"`--" <br />staff time, rental rates for facilities or equipment, etc.). Costs for City services vary and if f Yes, <br />`-"-""`-'-"`""'_i <br />I. <br />20-8756666 <br />approved, credit may or may not cover full cost of requested City services. ax to g: <br />Sfs o •. <br />City Services Credit <br />Amount Requested: i Date Needed. 49/15/2017 YdayodCouncilmem6er.I VI))egaS <br />Direct Payment Amount r1 000-1 <br />��Requested� r I � �_____ <br />/Event Date: 10/1 /2017 <br />- <br />Event Time: <br />l <br />- I <br />49-1 <br />/Event Location: I Birch Park <br />(Address, City.. State, Zip { 424 W. 3rd. st, SA 92701 <br />� - <br />IIIIrNationalSenior Citizen Day -----�-------------_�----_-- <br />Description of 1 <br />--_-------_--I <br />To celebrate the Seniors of SA & Senior cultural event. <br />IEventl Purpose: <br />We will need the stage and audio equipment for performers <br />This well be geared for seniors, but everyone is invited to the event <br />Community Benefit: There will be informational booths, performances by seniors, food truck <br />(Applicant Signature: <br />I r-+ - <br />---�.---. <br />I <br />ate: <br />-- <br />48/28/2017 <br />Mail: City Manager's Office -M-31 <br />Email: donationrequest@santaana.org i <br />20 Civic Canter Plaza <br />I Fax (714) 647.6994 <br />P.O. Box 1988 <br />Santa Ana, CA 92702 <br />-__ T-^ «—_-- <br />--- -- -- - ------_,__-� <br />_ <br />- _ <br />�—SDR <br />Donation Re uest #: <br />l R feren<e a on au related aAve Council Meeting Date: <br />SEPTEMBER 19, 2017 <br />Eligibility Met: j YES I NO YES ! Approved Amount: - <br />$1,000' <br />City Manager Signature j Date: <br />i- <br />Revised 01105/2017 <br />MO? <br />