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wa City Of Santa Ana City Manager's Office-M-31 <br />Civic Center <br />20 Plaza <br />Donation Request P.O. Box 1988 <br />• •;�,_•,,. Santa Ana, CA 92702 <br />- - (714) 647-5200 <br />• o • <br />Name ;Peter Mangosing �nu� Chief Instructor <br />ndd� rens: 118 W. Stevens Av. <br />'City, S zip: <br />-- <br />I Santa Ana Ca. 92704 kph a <br />714-745-7801 <br />Ema11E t: <br />tkksensei@te-kenjutsu-kan.com Fax: <br />rmatlOft, 7- <br />Name., Te-Kenjutsu-Kan Karate-Do Organization <br />Tax-Exempt Status: Is your organization a non-profit or public tax-exempt organization as <br />defined under Section 501(c)(3) of the internal Revenue Code? <br />fSelect One: <br />I I W] Yes ❑ No <br />IIF No, you will only qualify for a credit for Ct"fatedcosts foryourrequest(i.e. permittees, <br />0me, rental rates forfacdithes or equipment, etc.).Costs for Cityservices vary and if <br />r-- <br />�20-1371172 <br />(staff <br />approved, credit may or may not cover full cost of requested City services. IIf <br />1 ax lD III: <br />to a o <br />es <br />city, Services Credit—�—� <br />iAmeunt Requested: 1$ <br />ate Needed: <br />10/20/17 <br />IMayorlCouncilmembec Solono <br />Direct Payment Amount--�— <br />jRequested: x$500,00 Event Date: <br />11/12/17 <br />'IEventTime: 19:00am <br />Location: <br />FAdd-ss, <br />egerstrom High School <br />City State, Zip <br />[2301W. McArthur Blvd. Santa Ana, Ca. <br />Te-KenIwsu-Iran Karete4)o, l5themmel-Adlawan Cup Food Drive Mrste Championships. Whemmmm tltorsora requlmdlodonate,2-0msaF ,1 <br />DSSCrtpdOe 01 –Small Beg of Rloser Pasta,t-4 Pan[al Toilet popular, a 4-Pacitef PaperTowels. All donated goods gototm Wiselolacea sheltertorwomen inthe <br />Cayofsama Ane. We ere Me only tournament In Southern California evagives cut trophies foal eompealurs Net place in their d3visian. Theaebophlesare <br />Event l Purpose: handmade by the students and parents of Me TKK Organization. Eedr yearwe make over 4W trophies for our event. And we take mcch pdde tu the making <br />of 5 foot trophies for competitors B years and under. <br />The event benefits The Wseplece a Shelterfor Women in Santa Ana. The donated goods are much needed by the vromen transifioning <br />Community Benefit: from being homeless to sex-sufficient and empowered to make abetter life for themselves. By bringing our community togetherto help <br />organize the event it raises awareness to the needs of the ladies of the Wiseplam. It also benerits our youth in teaching them the <br />Importance of community service. <br />Applicant Signature: (Date: /0/7 <br />v <br />• a •• e <br />City Manager's Office-MJ9 <br />Ea -all donationrequest@santaanaorg <br />�Mail: <br />20 Civic Center Plan <br />P.O. Box 1908 <br />Fax: (714) 647-6954 <br />Santa Ana, CA 92702 <br />— <br />_-- ----� <br />Donation Request# DR- <br />Meeting Data- NOVEMBER 7, 2017 <br />IrCouncil <br />Eligibility Met: IYESINO YES I Approved Amount: $500 <br />Ctty Manager Signature: I Date: <br />� J <br />Revised 0 V0512017 <br />EXHIBIT 10 <br />29A-23 <br />