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City Manager's Ofllce- M-31 <br />City of Santa Ana 20 Civic Center Plaza <br />Donation Request P.O. Box 19118 <br />... Santa Ana, CA 92702 <br />(714) 647.5200 <br />Name: ---<_ t--- --Title <br />�Qgt/_9 F <br />6-Q (—_–_eco:Address- <br />- -- <br />City, State, Zip: (J —I-- ----- -- - --- — <br />sI-ho-ne—:a7 <br />�--- <br />- -�ll--y <br />Email: I:--�--�-6 <br />----�3----y-- <br />j Name: Charitable Ventures of Orange County fiscal sponsor for Wilshire Square Neighborhood Associatiol <br />Tax -Exempt Status: Is your organrzation anon-profn or public lax -exempt organization as <br />defined under Section 501(e)(3) of the Internal Revenue Code? I Select One: FMYes F]No <br />i If No, you will only qualify lora credit for C' -related costs Por your request (i.e. permit fees, F --- <br />staff time, rental rates for facildies or equipment, etc.).Costs for City services vary andif i f Yes, <br />approved, credit may or may not cover full cat of requested City services. ID It. � <br />- ---(Tax <br />-- <br />;• -. 1 14 <br />CHyServices CreditNeeded, Date F - -- - - <br />Amount Requested: I� ;Date Needed: I .�//J] �] Mayoj�J�`ouncllmember: VILLEGAS <br />,Direct Payment Amount I <br />Requested: 500 - Event Date: Eve t I <br />312A7 <br />�$ _ <br />/ I <br />-----�C.t2Si <br />Event Location: TI /E/G/IBOt;11o0p ` ei�BA�etzieso�s No PA.��c/4.1 <br />/ ) <br />(Address, CRY, State, LP . /n 0 UN re -P E <br />pit ) 7 <br />- <br />/-- --- -t-pOL/e <br />; Description of /70vN /TSL/�,A'i 1%9-e lgle IA'IaDLiJ/Gv <br />Event/Purpose:UqL(4/ <br />! _.- ----- ---- - sr94 � / 4 Lc N� Spr9✓�,'3/oaf �/ fL12X _rte -----I <br />j Community Benefit: �.iv i //L/ee- /f�f <br />/>t � i2��✓sp� -r <br />_ __ <br />'Applicant Signature: I - Date: <br />(Mall: City Manager's Office -M-31 �- Email: donationrequest@santa-ana.org <br />20 Civic Center Plaza Fax: (714) 647.6954 <br />P.O. Box 1986 <br />Santa Ana, CA 92702 <br />` <br />Donation Request 0: DR - <br />rrmronn c �n.-R r lama opus, Council Meeting Date: NOVEMBER <br />' <br />7, 2017 <br />Eligibility Met: YES l NO YES Approved Amount:i $500 <br />City Manager Signature: _ - Date:— <br />---- _ - -- - _I <br />Revised 01/05f2017 <br />y 7�� <br />2.7/18 L / <br />