HomeMy WebLinkAboutTUSTIN COMMUNITY FOUNDATION (2)Gift to Agency Re
1. Agency Name
City of Tustin
A Public Document
urvtston, uepart:meni, or rcegion pr appucaple)
Police Department -Santa Sleigh Program
300 Centennial Way
\rea Code/Phone Num
714-573-3285 I jblair@tustinca.org
Agency Contact (name and title)
George Vallevieni
2. Donor Name and Address
Date Stam
CITY OF ~USTI
1008 JUN - 8 A
^ Individual ^x Other Tustin Community Foundation
Last Name First Name Name
P. O. Box 362 Tustin CA 92781-0362
Address City State Zip Code
Philanthropic Organization
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:
Santa Sleigh Program $ 1,562.50
Name Amount
GIFT TO AGENCY REPORT
For Official Use Only
II
$ Amount
3. Payment Information
Date and Amount of Payment (other than travel) $
(month, day, year) (Round to whole dollars)
Travel Payment Information (Round to whole dollars) Location of Travel
Date(s) of Travel $ansportation 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:
Identify the officials for whom the payment was used:
Last Name First Name
Last Name First Name
Title
Title
Department/Division
4. Verification
I have determined that it is in the interests of the agency to accept this gift and use it for the official agency business described above.
i' .
Scott M. Jordan Chief of POlice 6-3-09
Signature of Age Head or Designee Print Name Title (month, day, year)
Comment: (Use this space or an attachment for any additional information )
^ Amendment (explain in comment section)
Date of Original Filing:
(month, day, year)
Name
DepartmenUDivision
FPPC Form 801 (June/08)
FPPC Toll-Free Helpline: 866fASK-FPPC (8661275-3772)