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~ SAN ~E9 <br />O ~(, <br />a O <br />ti <br />v' O <br />ti <br />~cO4POanTfo~~^ <br />Request for Use of City Council/Mayor <br />Community Empowerment Funds <br />Date: <br />I request that the amount of $ <br />be donated to which is an <br />approved recipient of City Council Community Empowerment Funds per <br />City Council Resolution. <br />Per the "Guidelines Regarding the Use of Community Empowerment Funds", <br />the purpose of donations is to respond to special requests from community <br />organizations, groups or individuals for support for community projects or <br />events. <br />The specific event/project/program the above funds will be used for is: <br />Councilmember's/Mayor's Signature <br />Approved by City Manager <br />Date <br />