HomeMy WebLinkAboutBRISCOE, PAUL & ROSEGift to Agency Report
1. Agency Name
City of Tustin
Department, or Region (ifappiicabte)
itreet Address
300 Centennial Way, Tustin, CA 92780
lrea Code/Phone Number E-mail
A Public Document
Date Stamp
Y Q~ i°US^i i~
ice Zo ~ ~a ~
GIFT TO AGENCY REPORT
For Official Use Only
^ Amendment (explain in comment section)
(714) 573-3010 cshingleton@tustinca.org
Agency Contact (Warne and title) Date of Original Filing:
(month, day, year)
Christine Shingleton, Assistant City Manager
Z. Donor Name and Address
x^ Individual Briscoe Paul and Rose ^ Other
Last Name First Name Name
Tustin CA 92782
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 Informatian
Date and Amount of Payment (other than traveq 2/9/09 ~
(month, day: year)
400.00
(ftound to whole dollars)
Travel Payment Information (Round to whore dorrars) 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:
Library Building Fund
Identify the officials for whom the payment was used:
Last Name First Name Title Department!Divisian
Last Name First Name Title DepartmenUDivision
4. Verification
! have determined that it is in the inferests of the agency to accept this gift and use it for the official agency business described above.
~r~r,~ ~ i•istine Shingleton Assistant City Manager 2/17/2009
ignature of Agency Head or D i nee Print Name Title (month. day, year)
Comment: (Use this spac ran attachment for airy additional infarmatiarr.)
FPPC Form 801 (June/0$)
FPPC TalE-Free Helpiine: 866/A8K-FPPC (866/275-3772)