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City of Santa Ana <br />s F7 <br />Donation Request <br />Z <br />peme: Tricia Nguyen <br />ddross: 1618 West First Street <br />stato,Zlp: (Santa Ana, CA, 92703 <br />tnguyen@soulhlandintegrated.org <br />IName: Southland Integrated Services, Inc <br />Tax -Exempt Statue Is your organization a non-profit or publle tax-oxampt orpaidzatlon es' 'Select One: <br />Oned under Sedlon 601(ox3) of Die Internal Revenue Code? ' <br />N No. you will oNy quaRy fera Credit for CiWelated costs for yourrequest (i.e. permit fees, <br />staff time, fentalrafes forfacrOAs or wdpmon4 etc.). Casts for Coy services varyomfif 7IrYea, <br />proved, credit may or may not cover fu0 cod ofrequesled City services. liax ID 0. <br />�tly services Credit ale Neededayor/CouncilmonAount Requested: II I0i <br />irect Payment Amount s425 Event Date: i <br />Requested: + I 6/16/18 (Event Time: <br />Event I-ocatiom `1618 West First Street, Santa Ana, CA 92703 <br />of <br />Community Benefit: <br />City Manager's OBke—M-31 <br />20 Civic Center Plaza <br />P.O. Boy 1988 <br />Santa Ana, CA 92702 <br />(714) 647-5200 <br />Chief Executive Officer <br />1714-620-7007 <br />I714-620-7097 — <br />ZYes O No <br />Senior citizen program event will be hosted on June 16th, free to the community <br />at the Southland Integrated Services where activities will be showcased for frl <br />The seniors will display their artwork and activities to the community. <br />Provide senior services and activities to the seniors at Southland Health Center. <br />The objective of the services is to keep our senior community active, engaged, <br />healthy, and happy, which is a benefit to the entire community of Santa Ana. <br />ltlrtt':1, !Date I05/30/201 g <br />(Mail: City Manager's Office —M31 <br />20 Civic Center Plaza <br />P.O. Box 1988 <br />Santa Ana, CA 92702 <br />nlf m!at•JOVVv <br />EII9lblllty Met: <br />Gly Mnnn�er Signaturo: <br />Emall: donationroquest@santa-ana.org <br />Fax: (714)647.6954 <br />- l Council Meeting Dale JUNE 19, 2018 1 <br />iApproved Amount:$425 <br />. I. Bale: <br />i <br />Revised 01105M017 <br />29AIT t0 <br />