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City of Salta Ana City Ma 20 CivcCenter Plaza <br />_ Donation Request P.O. Box 1988 <br />Santa Ana, CA 92702 <br />(714) 647 -5200 <br />s a e <br />Name: <br />Nicki Luna - Hernandez Title JFPNA Secretary <br />(Address: <br />[701 W Jonquil Road <br />city, State, zip:' <br />Santa Ana, CA 92706 <br />�Pnone: I <br />(310) 944 -0041 <br />Emau: � <br />nIuna21 @yaIn oo.com <br />Orgartizatio <br />Name: _ Jack Fisher Park Neighborhood Association <br />:�-- � ®____._____ mss__ <br />�_.�.— _ __ <br />Tax•Exempt Status: Is your organization anon- profit or public tax - exempt organization as f �— -- <br />Select One: <br />defined under Section 501(c)(3) of the Internal Revenue Code? <br />�❑ Yes � No <br />If No, you will only qualify for a credit for City - related costs for your request (i.e. permit fees, �� <br />staff time, rental rates for facilities or equipment, etc.). Costs for City services vary and if iIf Yes, <br />approved, credit may or may not cover full cost of requested City services. jTax ID #: <br />_---- <br />City Services Credit <br />g '� OOO <br />�_�--- <br />Date Needed: <br />��_ —_— <br />5/1 /17 MayorlCouncilmember:' <br />��� <br />Martinez <br />Amount Requested— <br />Daect Payment Amount <br />$ — <br />N/A <br />— ��.30pm <br />Event Date: <br />6/24/17 Event rime: <br />C <br />J - 9:OOpm <br />Requested: <br />Event Location: <br />Jack Fisher Park, 2501 N Flower Street, Santa Ana, CA 92706 <br />Address, City, State Zip <br />Kick -off to summer: family picnic and movie night for the four neighborhoods surrounding Jack <br />Description of <br />Event /Purpose: <br />Fisher Park. Credit would cover costs associated with the City hosting a movie night (i.e. movie <br />license, staff, and equipment fees). <br />Lends positive usage at the park for the surrounding neighborhoods; fosters a <br />community Benefit (continued effort by neighborhood associations to improve the environment at the park. <br />I <br />_ <br />Applicant Signature:. 'Date <br />- uJ <br />Wi6"qqMp-leto-dfoirm- <br />Via; <br />Mail: City Manager's Office —M -31 <br />20 Civic Center Plaza <br />Email: donationrequest @santa - ana.org <br />Fax: (714) 647 -6954 <br />P.O. Box 1988 <br />Santa Ana, CA 92702 <br />fa+N <br />Donation Request #: DR <br />Reference # on all related 0PVs <br />Council Meeting Date:. <br />Eligibility Met: YES./ NO - _ <br />Approved Amount: <br />City Manager Signature: <br />i <br />Date: <br />EXHIBIT 1 <br />Revised 11116/2015 <br />sIRCR <br />