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}+`• - . City Manager's Office - M-31 <br />City of Santa Ana 20 Civic Center Plaza <br />Ia Donation Request N -2017-248-B P.O. Box 1988 <br />Santa Ana, CA 92702 <br />- (714) 647-5200 <br />Contact frilbirmation <br />[Name: (A.C. Green �ritle; r resident & Founder <br />Addras5: <br />FAdd <br />904 Silver Spur Rd., Ste. #416 <br />(city, state, zip <br />Rolling Hills, CA 90274 Phone: x800 -AC -YOUTH <br />Email: acg reenyouthfoundation@gmail.com <br />Fax: <br />Name: <br />A.C. FGreen Youth Foundation <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 />Select One: <br />� <br />� <br />� <br />Yes ❑ No <br />If No, you will only qualify for a credit for City -related costs for your request (t e. permit fees, <br />If Yes, <br />staff time, rental rates for facilities or equipment, etc.). Costs for City services vary and if <br />approved, credit may or may not cover full cost of requested City services. <br />Tax ID #: <br />g5-4288507 <br />-- <br />AmCity Services Credit $ <br />---- --�-_ �— <br />Date Needed: Mayor/Councilmember: lViartlneZ <br />ount Requested: <br />�---- <br />DirectPayment Amount $1,000 <br />— -----y <br />jEv.ntDate: IjJune1-3 201}�IEventTime: All da <br />' <br />,Requested: <br />I I O I I <br />Event Location: Santa Ana - Leadership Program / Basketball camp for boys and ages 9-16 <br />girls <br />Address, City, State, Zip <br />Description of <br />The goal of the Leadership Program is to identify and encourage leaders among <br />Event I Purpose: <br />children who might otherwise be forgotten. <br />Unique opportunity for those who lack positive role models, are physically and/or <br />[Community Benefit: <br />emotionally abused, economically disadvantaged or victims of homelessness. <br />Applicant<Signature: <br />IA.C. Green (Dafe: `. 110/18/2017 <br />all: City Manager's Office - M-31 �IE"mail: donationrequest@santa-ana.org — <br />20 CMe Center Plaza <br />Fax: (714) 647-6954 <br />P.O. Box 1988 <br />Santa Ana, CA 92702 <br />Donation Request#.. OR .. - <br />PoeterencaxenaltrelaraaUpvs1, Council Meeting Date: NOVEMBER 7, 2017 <br />Eligibility Met YES I NO YES Approved Amount:$1,000 <br />_._ __.. _ .._. _ __r —__ .,.. <br />City Manager Signature Date: <br />EXHIBIT 2 Revised 01/05/2017 <br />