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CitOf Santa AnaCity <br />Donation Request <br />Manager's Ofgce–M-31 <br />20 Civic Center Plaza <br />P.O. Box f980 <br />Santa Ana, CA 92702 <br />(7f A) 047.5200 <br />r s e <br />Pr adresa: f 700 W. 3rd St A208 <br />ICry,state,zip: Santa Ana 92701— one: <br />714.401-8312 <br />�Emall: lety.leonlg6l@gmalf.com f Pax: <br />Y o � <br />rName:�— Charitable Ventures of Orange County <br />rTax-Exempt Status; Is your organisation a non-profit or public tak-exempt organization as <br />iSelect Ons: <br />defined under Section 501(c)(3) of the Internal Revenue Code? <br />®Yes No <br />staff bra 0,rents I rates for facilities or equipment etc.). Costs for qty aerVIGea vary and if �_-_ <br />( If No, you Oil only qualify for a credit for Offy-related costs for your request (i. a. permit fees, f Yes <br />'--'--`--� <br />approved, crept may or may not cover full cost of requests City saidices, ax IDs: <br />2( 0_8756660 <br />.. <br />9 <br />Cityservices credit 1r,.^— i I <br />Pmount Requested: jI atm a Naoded: 49/15/201 t7 hAayodCoundlmemhar: i `7(j g <br />D _ _W ------------ <br />Direct Payment Amount 1 000 <br />Requaatad: , vantDatei 10/1/2017 vent Time: <br />g-1 <br />Event Wcatlon: Birch Park <br />Addrass, Ctfy.,Mate, 210 424 W. 3rd. St. SA 82701 <br />National Senior Citizen Day <br />[Description <br />1To <br />of <br />celebrate the Seniors of SA & Senior cultural event. <br />vent) Purpose: <br />We will need the Stage and audio equipment for performers <br />geared for seniors, but everyone is Invited to the event <br />rThiswel;"�e <br />Benefit: e will be informational booths, performances by seniors, food truck <br />IICC�ommunity <br />(Applicant Signature: I 7Za 4W IData: T <br />—�` Ili <br />����. <br />8/28/2017 <br />..— _ <br />Mail: City Managers Office– M-31 � Email: donationrequest@santaana.org <br />FT.I <br />20 Civic center Plaza <br />lazFax: <br />FaX (714) 647.8984 <br />P.O. Box 1888 <br />sante Ana, CA 92702 <br />Donation Request W: DR .'".–`."��'" <br />nafaronco 8 on nl! related aPVs Council Meeting Data <br />SEPTEMBER 19, 2017 ! <br />Eligibility Met: YES I NO YES I Approved Amount: <br />$1,000 ' <br />City Manager Signature I I We: <br />Revised 01/09/2017 <br />