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Charitab(eVentures <br />of Orange County <br />Print Form <br />Distribution of Funds Form <br />Please fill out the information below so that we may process requested funding appropriately. Prior to submittal, note: <br />1) One check request per form (multiple line items permitted). <br />2) One recipient per form. <br />3) Include any supporting invoices or receipts. <br />3) 2101 E. 4th Street, Suite 180B, Santa Ana, CA 92705 (mail) / 714.647.0901 (fax) / info@charitableventuresoc.org (email) <br />4) Notification will be sent to Program Manager once DoF Form is received. <br />Program Jr. Ambassador Tennis Program -Henry T. Nicholas, III Foundation Date 3/1/10 <br />Amount Requested 50,000 <br />Category (see Distribution of Funds <br />Categories document) <br />Commissions & Fees <br />FUND RECIPIENT INFORMATION <br />Vendor <br />Junior Tennis Ambassadors, Inc. <br />Payable To Junior Tennis Ambassadors, Inc. <br />Street Address 23582 Via Paloma <br />City, State, Zip Coto de Caza, CA 92679 <br />Phone <br />Email <br />AUTHORIZATION <br />Fax <br />Amount <br />$50,000.00 <br />,r Mail Check to Recipient <br />rX Mail Check to Program Manager <br />Anne Olin, President <br />Date <br />Charitable Ventures of Orange County <br />/d <br />rector <br />Gerar"Ana- <br />Date <br />City oParks <br />----------------- <br />CVOC OFFICE USE ONLY <br />Date Request Received Date Check Sent <br />