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DocuSign Envelope ID: B9897EA3 -FA97- 4820- BE16- 377FBA3408DC <br />w: <br />�,,;,_' City of Santa Ana <br />t, Donation Request <br />IName: IMamie Funahashi <br />Address: 11000 N Alameda Street, Suite 240 <br />City, state, zip: Los Angeles, CA 90012 <br />Email: mfunahashi @CommunityPartners.org <br />Name: Community Partners <br />i ax- Exempt status: Is your organization a non - profit or public tax - exempt organization as <br />lefined under Section 501(c)(3) of the Internal Revenue Code? <br />If No, you will only qualify for a credit for City- related costs for your request (i.e. permit fees, <br />;tall time, rental rates for facilities or equipment, etc.). Costs for City services vary and if <br />tpproved, credit may or may not cover full cost of requested City services. <br />(rCity Services Credit Ir <br />Amount Requested; is Date Needed: <br />(Direct Payment Amount j <br />(Requested: j$ 1500 Event Date: <br />Event Location: 10/18 Green Parrot Villa, 2035 N Main St, Santa Ana, CA 92706 <br />Address, City, State, Zip <br />110/27 The Bicvele Tree. 811 North Main Street Santa Ana. CA. 92701 <br />IDescription of To support Media Arts Santa Ana (MASA) in the 7th OC Film Fiesta and to <br />Event l Purpose: provide free public screenings in Santa Ana's Ward 3. MASA is a <br />fiQrally_annnCnrpA nrniarf of (:nmmnnity PartnnrQ n 5n1lrwk9 non- nrnfif <br />Community Benefit: The Film Fiesta will spotlight N. Main as an area of cultural vitality, and the free <br />( <br />family screenings will promote community awareness & participation in cultural <br />!Applicant Signature: r° tL S (Date: 1 9/2/2016 <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 -5200 <br />CFO <br />Phone: 1213-346-32-06 <br />;Pax; 1213- 808 -1009 <br />(Select One: <br />I Yes ❑ No <br />r <br />If Yes, <br />Tax ID 0: 95-4302067 <br />Sept. 20 'Mayor /Councilmember: <br />10/18 & 10/27 IlEvent Time: <br />Amezcua <br />7pm <br />Mad City Manager's Office —M -31 Email donationrequest @santa - ana.org <br />20 Civic Center Plaza Fax (714) 647.6954 <br />P.O. Box 1988 <br />Santa Ana, CA 92702 <br />Donation Request tt:.. DR -- <br />Rcferencf $ vn af7 rcre?est rii °tr9 Council Meeting Date: <br />Eligibility Mot! YES I No Approved Amount <br />I <br />City Manager Signature: Date: - <br />i <br />EXHIBIT 1 <br />Revised 11/16/2015 <br />