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+:=r City of Santa Ana <br />Donation Request <br />-aur <br />tame; ITticte Nguyen — --- <br />�tdMaaa: � 1818 West Firsk S#teat <br />iRy,ststo.zhr ISanta Ana, CA, 92703 <br />�, W `t nguyen@sauthlandintegrated,org <br />City Manager's Coke — M-31 <br />20 Civic Center Ptaxa <br />t'.t) Bax 1989 <br />Santa Ana, CA 82102 <br />(714) so 6200 <br />Chief Executive Officer <br />�horwc 1714-620-7007 <br />1Fax: 1714-620-7097 <br />name+ JSouthiand Integrated Services, Inc. <br />TaxdExempt ffitatu ci Is you orgaNxaRxar a no4rc or public We eramPt otgsrkation as igelsat Ons: �t,�t <br />MOaad under Section 601(o)(3) of the Internet Revenue Code? l t r r Yes NO <br />X ft, you will only quality for a ersdif for CBy-refalodcosts for your request #.& permit teas, - 195-3403526 <br />.its#f rm, rentalrsfaa for (aorWas or equipment #to,),Cosls for City somlose vary and flrYas. <br />reproved, crecWt may or trey rat carer tubcost of requested Oily sorvfces. ax t 0: <br />�Cily Bervicos Credit <br />�imounl Requested <br />. <br />i .... I ..... . ....... <br />ltlaG Flooded: 106/30/2018 PayorlCouncilmember. VILLEGAS <br />iroct Payment Amauat <br />jjj i(!A 1 <br />vent [Bata: ef16/1 t# Thna: i t <br />egaestad: <br />iF.vsnt <br />I I <br />Event Lacation <br />�Ad"" <br />'1618 West First Street, Santa Ana, CA 92703 <br />Ca3' State zip <br />2 I <br />jjjijSenior citizen program event will be hosted on June 16th, free to the community <br />Description of <br />Event lParpaae: <br />j at the Southland Integrated Services where activities will be showcased for fie <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 />Community Benefit: <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 />ARROfaMi#tisnaturo;; <br />t nate, 105130/2018 <br />MMMOMMMEMM <br />Mail: City Manager's Office_ M-31 Email:donationroquest Santa ana.arg <br />1 20 Civic Center Plaza Fax; (714) 647.0904 <br />P.O. Bax 1008 <br />Santa Ana, CA 02702 <br />lineation Request1l: <br />` NnFo,� v,cadrrr, Of'WW ... )WIVs: <br />i StigtbltityAtet; <br />City Mannyer Signoture: <br />YESl ND YES <br />Crated Meeting Dato: <br />Approved Amount; <br />IMals: <br />EXHIBIT 12 <br />JUNE 19, 2018 <br />$425 <br />Revised 0110SM017 <br />