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City Manager's Office — M-31 <br />City of Santa Ana 20 Civic Center Plaza <br />Box 1988 <br />_ P.O. <br />7. Donation Request Santa Ana CA 92792 <br />(714) 647.5200 <br />Contact Information <br />Name: Laura Schlottman uq: Principal <br />ddress; 2840 West 1 st Street <br />city, state, zip: ISanta Ana, CA, 92703 Phone: 562-201-6968 <br />Emall: I Ibschlottman@magnoliapublicschools.org Fax: 714-242-1449 <br />Organization Information I I <br />Nama: Magnolia Science Academy Santa Ana/ Magnolia Educational & Research Foundation <br />Tax -Exempt Status: Is your organization a non-profit or public lax -exempt organization as Select One; Yes No <br />defined under Section 501(c)(3) of the Internal Revenue Code? ❑ <br />If No, you will only quality for a credit for City -related costs for your request (i.e. permit fees, If Yes, <br />stafftime, rental rates for facilities or equipment, etc.). Costs for City services vary and if L95-4649884 <br />approved, credd may or may not cover full cost of requested City services. Tax ID #:iSCat <br />SPM9-0t--MagMIla E-duca ia &-R�aYch Fooludat <br />0 <br />Donation . <br />City Services Credit �— <br />Requested: <br />Date Needed: <br />p <br />I t 1 D <br />Mayoricouncilmember: <br />navhtes1v'I �i �r,aQ <br />/ DD 11 <br />mount I <br />DirPayment Amount 5 () QQ U <br />Event Date: <br />zect <br />11.5 f <br />Event Time: <br />2 <br />$ Wye.-, <br />Regnested: <br />Event Location; <br />,�, <br />1l��Wwef-s mosewn <br />Address, City, Sfafe, Lip <br />-2,002, N . 1vlcxAVi S�- ) Sw- W` ANLI't CA, 92-:40 <br />We- WO & h Ve, 0 -jj&e_ oX a w avl cR toy try �td� 5 dents <br />t <br />Description of <br />Event I Purpose: <br />A ��{— r— <br />�t- (1 R�tL EI/t I ' iWV t `OT+�G�U-1f _s 4av: �G�I/Q� 111 sG141`r `l <br />A71c>_ cal -(fj i ✓ It i,,a avid IkIL'i n 4- 1A i (ecL 6uwn-5 . <br />W� WU14t ow yt y ccdot-ft 4V Vc+ l,�, -r c.& Cl'rt^')1�'t4_4Vf A <br />' <br />if <br />Community Benefit: <br />WLU5e_L'I;_ L-5 caZct t6'm n— e+'.�C.27 <br />Applicant Signature: <br />IDalo: <br />'Return <br />— — <br />completed form via: <br />Mail: City Manager's Office—M-31 iEmall: donationrequest@santaana.org <br />20 Civic Center Plaza I Fax: (714) 647.6954 <br />P.O. Box 1988 <br />Santa Ana, CA 92702 <br />` <br />Donation Request #: fidor # 60073 council meonng Date: OCTOBER 3, 2017 <br />[YES/ <br />Eligibility Met: NO YES Approved Amount: I $1,000 <br />j <br />City Manager Signature: ( Date:, <br />Revised 01/05/2017 <br />Ko;hw <br />