HomeMy WebLinkAboutDODGE, GLENN & STELLAGift to Agency Report
1. Agency Name
City of Tustin
Division. Department. or Region
City Manager's Office
Street Address
300 Centennial Way, Tustin, CA 92780
area Code/Phone Number E-mail
714-573-3010 cshingleton@tustinca.org
Agency Contact (name and title)
Christine Shingleton
2. Donor Name and Address
Cf
_ D~arte t~}F~'
~~' i U I I{`t
GIFT TO AGENCY REPORT
~r~ 2b A q= ob
For Official Use Only
^ Amendment (explain in comment section)
Date of Original Filing:
(month, day, year)
^x Individual Dodge Glenn & Stella ^ 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:
$ $
Name Amount Name Amount
3. Payment Information
Date and Amount of Payment (otnerthan travei) 1/23/09 ~ 400.00
(month, day year) (Round to ia~hole dollars)
Travel Payment Information (Round to whore dolrars) 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 far official agency business:
Tustin Library
Identify the officials for whom the payment was used:
Last Name First Name
Title
DepartmentlDivision
Last Name First Name Title DepartmenUDivision
4. Verification
I have determined that it is in the interesfs of the agency fo accept this gift and use if for the official agency husiness described above.
~~ Christine Shingleton Assistant City Manager 1/23/2009
Signature of Agency Head or a gnee Print Name Title (month; day, year)
Comment: (Use this sp e or an attachment for any additional information.)
A Public Document
FPPC Form 801 (June/08y
FPPC ToII-Free Helpline: 866/ASK-FPPC (866!275-3772)