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w City Manager's Office - M-31 <br />City of Santa Ana 20 Civic Center Plaza <br />Donation Request P.O. Box 1988 <br />Santa Ana, CA 92702 <br />- (714) 647.5200 <br />UritacUnf <br />.rJoseoJ <br />Name: Rea iTia(MPNATreasurer <br />�4ddress: _^ I516 E. OccidentaL St. <br />r —_« <br />city, state, zip: !Santa Ana, CA 92707ph,nl e, <br />714-357-6697 <br />k di �mason arna ma.com <br />Email: p �gi1`:Fax: <br />O o. r s t t p. • r <br />N e: [Madison Park Neighborhood Association (MPNA) <br />i 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? ISelect One: i � Yes ❑ l9n <br />IfNo, youwill only qualify for a credit for City -related costs foryour request (i.e. permit fees, 'If <br />Yes, <br />staff5me, rental rates for facilities or equipment, etc.). Costs for City services vary and if 180-0201690 <br />,approved, credit may or may not cover full cost of requested City services. :Tax ID 6: <br />i <br />tia l- •1. � <br />City Services Credit I I I <br />S Date Needed: i6/30/18 <br />'Amount <br />Requested: IMayorlCouncilmember: iBenavides <br />Direct Payment Amount $5�00 Date: I <br />8 <br />i.)1IE2018 £oerrt Time: 17 ma - 1pm <br />IEvent <br />Requested: <br />Evens Location. Madison Park 1528 S Standard Ave, Santa Ana, CA 92707 <br />IAdGN State, zip i <br />—� ;This year residents will complete a 5k walk along the bike trail from Edinger to <br />IDescription of i Chestnut Ave. Two police officers are needed at intersections that lack stop signs <br />IEventIPurpose: Ito ensure the safety of the participants. <br />i <br />MPN invites sponsors and community resources, which provided services to our <br />Community Benefit: ;community to empower residents to make healthier life choices. We anticipate an <br />;attendance of approximately 1,500, which consist of adults and children. <br />;Applicant Signature:—�. 'Data: <br />�Mail: <br />City Manager's Office-M-31 <br />Email: donafionrequest@santa-ana.org <br />20 Civic Center Plaza <br />Fax: (714) 647-6954 <br />P.O. Box 1988 <br />Santa Ana, CA 92702 <br />Donation Request#: i DR- I June 19, 2018 <br />Council Meeting Date: <br />R.ererence a att all related 0PVs ! I <br />Eligibility Met: YES I NO YES Approved Amount: $500 <br />City Manager Signature: ;Date: I <br />-- - <br />Revised 01ID52017 <br />2�i�T 626 <br />