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City of Santa Ana <br />DonationRequest <br />Name: Peter Mangosing <br />;Address: 118 W. Stevens Av. <br />City, state, zip: Santa Arta Ca. 92704 <br />Earl ,tkksensei@te-kenjutsu-kan.com <br />City Manager's Office - M-31 <br />20 Civic Center Plaza <br />Pi Box 9988 <br />Santa Ana, CA 82702 <br />(794) 647-5200 <br />title: Chief Instructor <br />'Phoreo: 714-745-7801 <br />;Fax: <br />Name: {Te-Kenjutsu-Kan Karate -Do Organization <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 />i If No, you will only qualffy for a credit for City-relafad costs for your inquest (i.e. permR fees, <br />'staff time, rental rates for fec tildes orequlpment, etc.).0osts for City services very and if <br />x ID 8: 2 ®-1371172 <br />approved, credit may or may not cover full cost of requested City services. ;Ta <br />'City Services Credit <br />Amount Requested: <br />,Date Needed: ,10(20/17 "Mayor/Councilme ial Solorio <br />/Direct Payment Amount <br />jRequastsd: <br />l <br />'$ 500.00 jEvent Data: i 11/12117 '/Event Time: 9:00am ; <br />/Event t.ocathen: <br />! Segerstrom High School <br />Address, City, state, zip <br />, 2301 W. McArthur Blvd. Santa Ana, Ca. <br />III TeuKanj itau-Ken Karate -Do, 16th annual-Adlawan Cup Food Drive hotels Championships. Where All competitors are required to donate, 2 -Cans of Food, 1 <br />!Description of <br />-Small Bag of render Pastel -4 Pack of Toilet Paperor, a 4 --Pack of Paper Towels. All donated grew go to the Warriors a shelter forwomen in the <br />City of Senta Ane. We are the only tournament in Southern California that gives out trophies to all competitors that place in theirdlvislon. These trephles ere <br />Event I purpose: <br />hand made by the students and parents of the TKK Organization. Each year we make over 40D trophies for our event. And we take much pride in the malting , <br />Of 5 foot trophies for competitors 5 years and under. <br />-. The event benefds The Wseplace a Shelterfor Women In Santa Ana. The donated goods are much needed by the women hansitioning <br />Community Benefit: <br />from being homeless to self-sufficient and empowered to make a better life for themselves. By bringing our community together to help <br />!, organize the event it raises awareness to the needs of the ladies of the Wasteland. It also benefits our youth in teaching them the <br />'�. importance of community service. <br />Applicant Signature:._. <br />g <br />Date: <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 1988 <br />Santa Ana, CA 92702 <br />Do anon dt¢at;Y•: D3_ �Cul1 3Iv1-h'0ic t.,; <br />iAgihiiiky Aiiei: Els, Pd(J YES _. Apurn...x! A.mrnrnt:... <br />City ll c i t qr aztre: <br />EXHIBIT 10 <br />NOVEMBER 7, 2017 <br />$500 <br />Revised 01/05(2017 <br />