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City of Santa Ana <br />F-R, <br />iPi�' Donation Request <br />p, <br />City Manager's Office - M-31 <br />20 Civic Center Plaza <br />P.O. Box 1988 <br />Santa Ana, CA 92702 <br />(714) 647.5200 <br />Contact information 0 <br />Name: <br />Patricia Wenskunas <br />itie: 1 <br />Founder CEO <br />Address: <br />11301 North Tustin Ave., Suite A <br />city, state, zip: <br />I Santa Ana, CA 92705 Phone: (844) 853-HOPE (4673) <br />Email: <br />patricia@crimesurvivors.org <br />Fax: <br />(775) 245-4798 <br />Organizatiori Information <br />Name: <br />Crime Survivors i <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 />I elect One: <br />Yes ❑ No <br />If No, you will only qualify for a credit for City -related costs for your request (i.e. permit fees, <br />staff time, rental rates for facilities or equipment,etc.). Costs for City services vary and i/ <br />full City <br />r-yxes._-',[ <br />30-0229425 <br />approved, credit may or may not cover cost of requested services. <br />Donati6n,Request <br />Cityservices Credit --9--CT7� Date Needed: June ZH, ZO18 Mayoncttuncilmember. I Solorio <br />Amount Requested: <br />Direct Payment Amount 1 575 ,Event Date: June 28. 2018 Event Time: No Set Time <br />Requested: <br />Event Location: <br />F3�Noh Tustin Ave., Suite A Santa Ana, CA 92705 <br />Address, City, State, Zip <br />Description of <br />Founder's Birthday Fundraiser Event for Victim of Crime Programs <br />Event/Purpose: <br />00% for Victims to have hope, healing, and survival! <br />Direct Program Support for Victims of Violent Crime: Art for Healing Classes, Self <br />Community Benefit: <br />Defense & Safety Classes, PEP Classes, Food, Clothing, Transportation & More <br />Applicant Signature: <br />GQIJ�D <br />Date: <br />June 11, 2018 <br />Return completed <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 />Win °CT&Lvf <br />Donation Request* <br />Reverence # on all related OPVs <br />DR- <br />Council Meeting Date: <br />June 1$, 2018 <br />Eligibility Met: <br />YES / NO YES <br />Approved Amount: <br />$1 ,575 <br />City Manager Signature: <br />Date: <br />Revised 01/05/2017 <br />