Laserfiche WebLink
. ' Ctry Manager's Offico - M-31 <br />City ol'Santa Ana 20 Civic Confer PAnm <br />P.O. Box 1080 <br />D011at'(dh7 RequesttSanto Ana, GA 92702 <br />••,. (714) &i7.0200 <br />Name; <br />' w� _ lJ..`"-"'---��-""-•---�—^-Lam'=�, <br />AAddrost''� Y Q �•�/• <br />City, 5htta, gip; .A. !.�' ti �•")�Cl QY phone; <br />Email; a4AA.:.. GU-C�- C.� _ Fax: <br />...�_.-- <br />Name; <br />Tax•6xempt3tatus: is your orgoehatlona non•profit or publiotex-exampt organization as a12CE0ao: �I" <br />relined under Section 501 (c)(3) of Ih InPemal Revenue Code4 �, I <br />� Yea No <br />00,you W11 only qualily for a ors(&the City-ro/ated casts foryour request li,e• psm1f fees, <br />sfaff8me, rental rates forfecilldos er equipmen;efm).Cosfa for City s9mYces vary and if If Yea, <br />approved, craditmayer,may nofroNfrfull Cost of requested City w4ees. iTax in 0: I <br />�- <br />�7 <br />3-. byr/ <br />unt Requ=d: Bate Needod; <br />�%Cdy Services Cradh �I$ <br />r <br />&r� atp( <br />D+lCouncllmemhsr. <br />ffI + <br />If ,, <br />Cireot Payment Amount <br />S Event 0dte: OEvent Time: a fl-"- <br />Event Location: <br />Adare9a, city, state, Lp <br />IjI i1 a� (r t,p..yt..+e.a-e.. yam+ w-ILAI ��• o� "74+}- <br />. Description n of �i <br />'Event! <br />�='r'� `� � 'Q' 0, VP- A) <br />Purpose: <br />e- V','t) d/ <br />. Community Bonefih <br />� <br />�"=•�:�D y' „h �� S' <br />� ,C(,� / <br />Moil: City Manag®r's Office-U411 <br />Enroll: donadonrequast�santa.ana.org <br />20 CIVIC Confer Plaza <br />Fax: (714) 0d7.0934 <br />P.O, nag 1908 <br />I <br />Santa Ana, CA 92702 <br />Donation Roquest#: CouneiV'MnoS�g f)clle; . <br />tdererempA# on allrelatedtS'Pvs' ._._—•,�..._ '04/18/2017W--_.--._ <br />elinmulty Mot r S f No YES' Appravad •Amount $1,000 <br />City Manager 5iggatua Dam <br />vi <br />Radsed 0110512D17 <br />Exhibit <br />". L"l? <br />