HomeMy WebLinkAboutKASPARIAN, SUSANGift to Agency Report
1. Agency Name
City of Tustin
Division, Department, or Region (if applicable)
300 Centennial Way
Street Address
Tustin, CA 92780
Area Code/Phone Number I E-mail
*1M;
GIFT TO AGENCY REPORT
Date Stamp
CITY OF TUSTI
1009 JAN - 8 A 10: 10 3
For Official Use Only
❑ Amendment (explain in comment section)
714-573-3107 1cshingleton@tustinca.org
kgency Contact (name and title) Date of Original Filing:
Christine Shingleton, Assistant City Manager
2. Donor Name and Address
(month, day, year)
❑x Individual Kasparian Susan ❑ Other
Last Name First Name Name
Tustin CA 92780
Address City State Zip Code
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:
Susan Kasparian
Name
3. Payment Information
400.00 $
Amount Name Amount
Date and Amount of Payment (other than travel)
(month, day. year) (Round to whole dollars)
Travel Payment Information (Round to whole dollars) Location of Travel
Date(s) of Travel Transportation 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:
Identify the officials for whom the payment was used:
Last Name First Name
Last Name First Name
4. Verification
Title
Title
Department/Division
Department/Division
t have determined that it is in the interests of the agency to accept this gift and use it for the official agency business described above.
Christine Shingleton Assistant City Manager 12/30/2008
igrikure ooAcy Head or Designee Print Name Title (month, day, year)
Commentthis space or an attachment for any additional information.)
FPPC Form 801 (June/08)
FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772)