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City of Santa Ana <br />Donation Regtiest <br />Name: �- <br />'l" V><Znt <br />Address: <br />City, State, Zip: /n� <br />Ce cL t 1 b -Le <br />Email: P <br />City Manager's Office - M•31 <br />20 Civic Centel' Plaza <br />P.O. Box lose <br />Santa Ana, CA 92702 <br />(794) &476200 <br />Title: LJ O(' Vt..� ' <br />'--�' �. l,iG't 1 Y'' P.04- j0 <br />J'cr S{c�Sic(P���_ I✓''7 <br />i" <br />Phone: <br />Fax: <br />Name: <br />CTjd-�111��1i.YP ?(ftGi�E UC%1�I <br />uiro5 <br />Tax -Exempt Status: Is your organization a on•proht or public tax-exempt organization as <br />defined under Section 501 (0)(3) of the Internal Revenue Code? Select One: Yes No <br />If No, you Wil only quality for a c edt forCityrelated costs foryour request (i.e. permit fees, <br />staff time, rental rates for facilities or equipment, etc.), Costs for City so ices very and if if Yes, _ <br />approved, credit may or may not Dover full cost of requested City services. Tax ID M �} .. �., S 6 6 6 f <br />CityServlces credit May <br />$ Date Needed: = C; _ _ <br />Amount Requested: j - �.G('j or/Councllmember: Please Choose From the List Below <br />Direct Payment Amount 3 Event Date: _ ' ` ' r ; <br />Requested: Cj(� �y -�7 t Event Time: M Ayt �pUL\ <br />Event Location; T v 1 r is E c.. t v < cri� -rGt) of '1e a 5� ' i l r5 [ -// <br />Address, City, State,. Tip 1 <br /><, t' <br />Description of <br />Event Purpose: <br />Community Benefit: <br />Applicant Signature: <br />C <br />'^� <br />, iC " ...1 fi� t t ct d Tic Lt i C.- c; 0, <br />( `� / 49�i C.0 <br />F' CC �'�4t ! e v`` \} G' �-- "\"L.a.. l Q i 4 \ i✓l (-_rG� f '> "(��' c C (P 6r't-1 Q <br />`l Vl VL'1 /�Si (,14 L.K. j, C.. l,t "t CSY._ r' ."i'�i.�4-"�6t f,j ...J�VI KG: G.Q 6i Y1 Q't- V`I.. <br />/JI,C t I V �.. <br />f'GL2r✓I�CLrt' a C4 vi 1 c# of 1t ('r �c� �Lt <br />t <br />L4 r v��� `- 4 i % �t..e� S b� 5 R O J C' ar / C- �'.. we Ger �e e.r >~ <br />Mail: city Manager's Office -M•31 <br />20 Civic Center Plaza <br />P,O. Box 1988 <br />Santa Ana, CA 92702 <br />Date: I / <br />Email: donation requestasanta.ane.org <br />Fax: (714) 6474954 <br />zC) r <br />Revised 11/16/2015 <br />