HomeMy WebLinkAboutDEVINE IMAGEGift to Agency Report A Public Document GIFT TO AGENCY REPORT
agency Name
City of Tustin
Police Department
itreet Address
or Region (if applicable)
300 Centennial Way
-rea Code/Phone Number E-ma
714-573-3306 I Pfoley@tustinca.org
-gency Contact (name and title)
Penni Foley, Administrative Secretary
2. Donor Name and Address
zoos ocj 2 u
For Official Use Only
I~ 32
^ Amendment (explain in comment section)
Date of Original Filing:
(month, day, year)
^ Individual Sarmiento Lieber (Owner) ^x Other Devine Image
Last Name First Name Name
13132 Newport Avenue, Suite 200 Tustin CA 92780
Address City State Zip Code
Business
If "Other' is marked, describe the entity's business activity (if business) or its nature and interests.
--__
If applicable, identify the name of each source and the amount(s) solicited or received by the donor for this gift:
Devine Image $ 300.00
Name Amount
Name
Amount
3. Payment Information
Date and Amount of Payment (ornertnan ravel) $
(month, day, year) (Round to whole dollars)
Travel Payment Information (Round to whole aorlars) Location of Travel
Date(s) of Travel $ansportation Expenses $ Lodging Expenses ~ Meal Expenses $ Other Expenses $ Total Expenses
Provide a specific description of the nature and use of the payment for official agency business:
Four spa and skincare gift certificates, which were given as door prizes at the Neighborhood Watch Captains' Network
meeting.
Identify the officials for whom the payment was used:
Four different residents of the community No City Officials received these gifts
Last Name First Name Title Department/Division
Last Name First Name
Title
Department/Division
4. Verification
I have determined that if is in the interests of the agency to accept this gift and use it for the official agency business described above.
~_ Scott M. Jordan
Signature of Agen ead or Designee Print Name
Comment: (Use this space or an attachment for any additional information.)
D~ ~~i"''~ F T
Chief of Police
rifle
10-23-08
(month, day, year)
FPPC Form 801 (June/08)
FPPC Toll-Free Helpline: 866/ASK-FPPC (8661275-3772)