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City of <br />Donation <br />'Address: <br />City, State, Zip: r <br />SA <br />r -_ <br />Aj <br />Email: -- I -he M, <br />Ana <br />Title: <br />9 U 7Y.—t31jec// Sy — <br />,C 0/v IFax: <br />City Manager's Office - M31 <br />20 Civic CenterPlaza <br />P.O. Box 1988 <br />Santa Ana, CA 92702 <br />(714) 647-5200 <br />j Name: J� Charitable Ventures of Orange County as Fiscal Sponsor for Wilshire Square Neighborhood <br />Taxx-ExeExempt Status: isyour organization a non-protn or pubac td -X empt organization as r� <br />defined under Section 501(c)(3) of the Interial Revenue Code? �Seiect One: M Yes I LL1 No <br />I I1 No, you will only qualify for a credit for __ii <br />staff time, rental rates for facilities or equ, <br />'approved, credit may or may not cover fu <br />Amount <br />Amount ':$1,000 <br />'Event Location: DIC <br />Address, City, State, Ztp <br />, 177 <br />Description of <br />;EventI Purpose: <br />jCommunny Benefit: <br />Applicant Signature: <br />ated costs Por your request (i.e. permit fees, <br />etc.). Costs for City services vary and if <br />f requested City services. <br />Needed: <br />rent Date: I-/�- 3 . / 7 IIS <br />(UG/%Aotlloon iQAFC, <br />_UU 7/yDSS <br />_ <br />/�4✓1V Ulf L /Tr/L /�,>FY /i9Q,�Jp� <br />Ape <br />A24 <br />i Mall: City Manager's Office -M31 <br />20 Civlc Center Plaza <br />P.O. Box 1988 <br />Santa Ana, CA 92702 <br />If Yer---- <br />ITax ID W. 20-8756660 <br />Mayor Pulido <br />r70 W rg-p <br />/A/61,le- ov YOL/e <br />/.�uUDG��rr��ur ,�p1L <br />i i2��✓s p�si�rv�_i�UrT y C�/r-5' �ciccASe <br />Date: <br />Email: donatlonrequest@santaana.org <br />Fax: (714) 6475954 <br />T - - -- — <br />Eligibility tv9et; a rvlarrd rr vs YES 1 NO <br />council Meeting Date <br />: NOVEMBER 7, 2017 y' <br />Donation Request :t: DR- <br />,nlrrenrc <br />9 y _ , YES Approved Amount: I $1,000 <br />I City Manager Signature: Date: <br />Revised 01/05/1017 <br />