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City of Santa Ana City Manager's Office—M-31 <br />yp y 20 Civic Center Plaza <br />Donation Request P.O. Box 1988 <br />v -_L' Santa Ana, CA 92702 <br />-- - (714) 647-5200 <br />[Name: 'IJohanthan R. Hernandez I[ritle: iIFounder and Executive Director!I <br />E, chestnut Ave, Unit # A <br />657-261-1653 <br />Name: II Santa Ana Unidos I <br />Tax -Exempt Status: Is your organization a non-profit or public tax-exempt organization as Select One: <br />defined under Section 501(c)(3) of the Internal Revenue Code?Yes ❑ No <br />If No, you will only qualify for a credit for City -related costs for your request (i.e. permit fees, <br />staff time, rental rates for facilities or equipment, etc.). Costs for City services vary and if�__1147-5211563 <br />Yes, <br />approved, credit may or may not cover full cost of requested City services. Iax lD#: 1 <br />„ - <br />City Services Credit <br />Date Needed: 10/28/2017 Mayor/Councilmember: <br />j <br />Sarmiento <br />mount Requested: 11 <br />NOVEMBER 7, 2017 <br />irgect Payment Amount ''I$1 OOO Event Date: ! 10/28/2017 IEvent Time: _ _i 6:00 PM -10:00 PM <br />Re uested: i <br />YES I NO YES <br />Approved Amount: <br />Event Location: <br />505 E. Central, Santa Ana, CA 92705 <br />Address, City, State, Zip <br />Date: <br />i <br />Description of <br />romote alternative and effective forms of youth rehabilitation programs to incarceration. <br />Event I Purpose:borhoods <br />d ceremony tohighlight positive Santa Ana role models who came from our local <br />raa <br />and attain success and recognition for their achievements. <br />Emotional development for youth and engagement of community to address the <br />Community Benefit: <br />underlying conditions that contribute to gangs and deteriorating neighborhoods. <br />Applicant Signature: <br />/�y�(�(,�y(� �j�yydy� <br />Date_ <br />1 OI1 .7I201 7 <br />Mail: City Manager's Office—M-31 Email: donationrequest@santa-ana.org <br />20 Civic Center Plaza Fax: (714) 647-6954 <br />P.O. Box 1968 <br />Santa Ana, CA 92702 <br />armf`,M °' yv <br />Donation Request #: <br />Reference # on all related DPVs <br />DR <br />Council Meeting Date: <br />NOVEMBER 7, 2017 <br />Eligibility Met: <br />YES I NO YES <br />Approved Amount: <br />$1,000 <br />City Manager Signature: <br />Date: <br />