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City of Santa Ana <br />Donation Request <br />CIO Manager's Otfiee— M-31 <br />�flvlc Center Plaza <br />P.O. Box 1988 <br />Santa Ana, CA 92702 <br />(714) 647.5200 <br />Contact Information <br />Name: <br />INatiAlvarado File. <br />I Executive Director <br />ddress: <br />11920 E. 17th Suite 202 <br />Ity, state, MP: <br />Santa Ana, Calif. 92705 hone; <br />714-267-7747 <br />IEmall: <br />nati@ngservices.org <br />Fax: <br />Name: INatis House DBA Neutral Ground <br />tempt status: Is your organization a non-prord or public tax-exempt organization as <br />under Section 501(c)(3) of the Internal Revenue Code? <br />ou will only qualify fora credit forCify-related costs for your request (l e. permit fees, <br />e, rental rates forfac7illes or equipment, etc.). Costs for City services vary and if <br />d, credit may ormaynot cover full cost of requested City services . . <br />FVJ Yes No <br />raxy"'45-4041042 <br />D N: <br />Donation Request <br />Ily Services Credit <br />Itunount Requested: <br />ate Needed: <br />6-23-2018 ayoricouncilmember. <br />Yllegas <br />IrectPayment Amount <br />Requested: <br />250.00 vent Date: <br />6-23-2-018 veneTime:12:00pm <br />Event Location. <br />Ivic enter r Santa Ana, a. 92706 <br />Address City, State, Zip <br />use provides mediation an intervention services to ants a youth <br />Description of <br />7andlies in need. The funds from this sponsorship will go towards on -going <br />EventIPurpose: <br />cost and services through June 30, 2018. <br />e community benefits from Natis House services and program by overcoming <br />Community Benefit <br />life challenges, learning workforce skills, completing educational opportunities. <br />Applicant Sig nature: <br />f -!%%� ✓ <br />ate: <br />-08-2Q16 06 <br />Mail: City Manager's Office—M-31 raxa <br />ll: donationrequest@santaana.org <br />20 Civic Center Plaza (714) 647-6964 <br />P.O. Box 1988 <br />Santa Ana, CA 92702 <br />•� , ,��-,v err, _... .,. ___ .... _. .. _ - _... . <br />Donation Request p: <br />DR. <br />Council Meeting Date: <br />dune ts. 2076 <br />Reference a on all related DPVs <br />Eligibllity Met: <br />YES I NO 'Rs <br />Approved Amount: <br />$250 ' <br />City Manager Signature: <br />Date: <br />29A-38 <br />Revised 01/05/2017 <br />