HomeMy WebLinkAboutGEORGESON, KRISGift to
1. Aaen
Report A Public Document
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Area Code/Phone Number
Agency Contact (name and tit e)
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2. Donor Name and Addre9
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individual
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^ Other
Date Stamp
CI ~ '~ 0~ TUS1-
GIFT TO AGENCY REPORT
For Official Use Only
1008 M~iR 2u A II~~ 08
^ Amendment (explain in comment section)
Date of Original Flling:
(month, day, yeah
Nam
k "OtTier"is marked, describe'the entity's business activity (H 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:
Na a Amount Name Amount
3. Payment Information
Date and Amount of Payment (ornerrnan 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:
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Identify the officials for whom the payment was used:
Last Name First Name Title DepartmenUDivision
Last Name First Name Title DepartmenUDivision
4. Verification
I have determined that it is in t int ests of the agency to accept this gift and use it for the official agency business described above.
Comment: (Use this space or an attachment for any additional information.)
Title (month, day, year)
FPPC Form 801 (June108)
FPPC Toll-Free Helpline: 866/ASK-FPPC (8661275-3772)