HomeMy WebLinkAboutOVERN, BUDGift to Agency Report
1. Agency Name
City of Tustin
Department, or
on (if applicable)
A Public Document
D~a^te Stamp
C, I ~ OF~ ~U~J
200q FEB 2 ~ /~
300 Centennial Way, Tustin, CA 92780
GIFT Td AGENCY REPORT
For Official Use Only
20
^ Amendment (explain in comment section)
(714) 573-3010 cshingleton@tustinca.org
Agency Contact {name and title) Date of griginal Filing:
(month, day, year)
Christine Shingleton, Assistant City Manager
2. Donor Name and Address
~ Individual Overn Bud ^ Other
Last Name First Name Name
Tustin CA 92705
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 (ornerrhan waver) 2/26/2009 ~
(month, day year)
400.00
(Round to whole dollars)
Travel Payment Information (Round to whole darars) 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 DepaRment/Division
Last Name First Name
4. Verification
Title
DepartmenUDivision
! have determined that it is in the n~terests of the ager7cy to accept this gift and use it for the officio( agency business described above.
Christine Shingleton Assistant City Manager 2/26/09
Signature of Agency He or signee Print Name Title (month; day, year)
Comment: (us is space or an attachment for any additional information.)
FPPC Form 801 {June/08)
FPPC Toll-Free Helpline: 866/ASK-FPPC (8661275-3772)