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City of Santa Ana <br />Donation Request <br />City Manager's Office — M-31 <br />20 Civic Center Plaza <br />P.O. Box 1988 <br />Santa Ana, CA 92702 <br />(714) 647.8200 <br />Name: jAmerica Bracho- -- <br />itle CEO <br />ddross: 450 W Fourth St <br />sty, state, zip: Santa Ana, CA 92701 Phone: (714) 542-7792 ext 1009 <br />Eman: Iruiz@latinohealthaccess.org, cachamaure@aol com Fax: x(714) 542-4853 <br />lLetino Health Access tLaunO ~,,enter ror rreventlon & Action in Health & Welfa-re)-- <br />npt Status: Is your organization a non-proft or public tax-exempt organization is m -elect One: <br />ider Section 801(c)(3) of the Internal Revenue Code? ® Yee I I No <br />011 only qualify lora oredit for City -related costs foryour request(Ia. permit fees, <br />rental rates forlaciintes orequipment,etc.).00sfs for Cityservices vary andif ` <br />credit may ormay not coverfull cost ofrequested Cityservices. Tax lO la. 133-0562943 — <br />Credit <br />Needed: <br />Amount t 1500 1EventDate: 14/7/2018 1EventTime: �$ 00 alp <br />zn <br />Centennial Regional Park, 3000 W Edinger, Santa Ana, CA 92704 <br />Desrription u' 5K Health Walk - Caminata por la Salud <br />Event Pur(JPSw1 <br />To promote awareness among Santa Ana residents on the importance of physical and <br />Community Benefit: emotional wellbeing, its impact on our community, and the growth of a healthier city. <br />APpgoant signature 04/05/2018 <br />Mall: City Manager's Office—M-31 <br />20 Civic Center Plaza <br />P.O. Box 1988 <br />Santa Ana, CA 92702 <br />Email: donationrequest0santaana.org <br />Fax: (714) 641-6964 <br />Donation Request it DR Council Mectlnr,1 Data: May 15 2018 <br />Reference # an all r, la red DFUs y e <br />Eligibility Met: YES I NO Yes j Approved Amount: $1,500 <br />City Manager Signah,ro:. Date <br />Revised 01/0 512 01 7 <br />