HomeMy WebLinkAboutTUSTIN MAN & WOMAN OF THE YEARGift to Agency Report
1. Agency Name
City of Tustin
Division, Department, or Reg
A Public Document
7' r- D7a-te Sta_mpt,~
CI I QI 1 UCJ ~ (tai
n
'street AtldreSS
300 Centennial Way, Tustin, CA 92780
-rea Code/Phone Number E-mail
(714) 573-3010 I cshingleton@tustinca.org
Agency Contact (name and title)
Christine Shingleton, Assistant City Manager
2. Donor Name and Address
(month, day, year)
^ Individual Q Other Tustin Man & Woman of the Year
Las4 Name First Name Name
14645 Red Hill 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 Hams of each source and the amount{sj solicited or received by the donor for this gift:
$ $
Name Arrtount Name Amount
3. Payment Information
Date and Amount of Payment (other than traver)
2/3/2009
(month, day year]
1009 F~~ 18 !~ 3~ 4 q
GIFT TO AGENCY REPORT
For Official Use Only
^ Amendment (explain in comment section)
Date of Original Filing:
11,100.00
(Round to whole dollars)
Travel Payment lnfarmation (Round to whore dollars) Location of Travel
Date(s) of Travel 7ransporfation 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:
Library Building Fund
Identify the officials for whom the payment was used:
Last Name First Name
Last Name First Name
title
Departmenb'Division
4. Verification
! have determined that it is in the interests of the agency to accept this gift and use if for the official agency business described above.
~~-~' Christine Shingleton Assistant City Manager 2/10/09
Signature ency Hea r Designee Print Name Title (month, day, year)
Comment: (Use this space or an attachment for any additional information.)
Department!Division
FPPG Form 801 (June/08)
FPPG Tall-Free Helpline: 8661ASK-FPPG (866!275-3772)