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EXHIBIT 3 <br />29A-9 <br />ysW,y{ -:. City Manager's OfOce-M-3f <br />.1`k,�,7:...". City of Santa Ana 20 Civic Center plaza <br />�'_'",=]P. Donation Request P.O. ecx 1988 <br /><•�,¢P Santa Ana, <br />CA 92702 <br />(714) 647-5200 <br />arae; ILeon,9. Jacobs G p Sym V�ir'1�1 hp lie: President <br />Address: rz �5i �• C f Sl It lD' <br />City, State, Zip: <br />F -,s0 y*j Af cA Ri-i65 <br />phone: <br />(714) 745-6232 <br />Emag: <br />Ieanjacobs20@gmail.com <br />• . <br />Nemo: <br />Bella Vista Neighborhood Association c!o Charitable Ventures O Count <br />Tax-Exempt Status: Is your organization a non-pmfit or public tax-exempt organization as <br />defined under Section 501(c)(3) of the Internal Revenue Code? <br />Select One• <br />_ Yea <br />❑ No <br />If No, you will only qualify for a credit for City-related costs for your request fie, pemJt fens, <br />tafrtima, rental rates fortacNlies or equipment,etc.). Costs for City services vary and If <br />approved, Credit may or may not cover full coal of requested City services, <br />Yes, VO-8756660 <br />r11lD 4. <br />•.M1. ff. -. <br />Ity Services Credit <br />(Amount Requested: <br />IS —Dale <br />Needed: <br />IaSa p <br />MayorlCounctimember: <br />Benevides _. . <br />DI qct Payment Amount $ 330.00 Event Date: t 2-8-t 7 Event Time: <br />e uested: 5Pnl- Bpm <br />Location: Jerome Park 726 South Center Street Santa Ana CA 92704 <br />F <br />s, Cky, Slafe, Zlp <br />. <br />Reimbursement for OCFA specielevent permit fee for.100+chidron and families to enjoy neighborhood <br />Description of <br />movie night featuring Moana. Event was planned with youth in government program and volunteer parent <br />Event/ Purpose: <br />leaders at Monte ElementaryVista School, adjacent to the neighborhood park. <br />All community members were Invited to attend. Events like these are much needed, especially In <br />F,,mu,,,YBenegt : <br />thsi area where existing Townsend civil gang injunction Is in place. Successful movie night drew <br />a large turnout on a Friday night. NA plans on holding additional movie nights duringg the <br />Appilcant Signature: <br />fsummer. <br />NIM-1. <br />Mail: City Manager's Office-M-31 <br />Email: donaUonrequest@santaana,org <br />20 Civic Center Plaza <br />Fax: (714) 847.8954 <br />P.O. Box 1088 <br />Santa Ana, CA 92702 <br />fr <br />Donation Request 0: j OR April 17, 2018 <br />Reroroncn 0 nn A re/Md OPVs l I Council Meeting Date ; ; <br />Ellgihillty Met: YES INO YES 1 Approved Amount: 1 $330 <br />City Manager Signature; Date: <br />Revised 01/0512017 <br />EXHIBIT 3 <br />29A-9 <br />