HomeMy WebLinkAboutROUGH-FIT, INCGift to Agency Report
1. Agency Name
City of Tustin
Division, Department, or Region (if applicable)
Parks and Recreation
300 Centennial Way Tustin, CA 92780
(714) 573-3333
(name and title)
A Public Document
sking@tustinca.org
Sarah King, Recreation Coordinator
2. Donor Name and Address
GateTStvamp C'
2009 JUN 2 5
GIFT TO AGENCY REPORT
For Official Use Only
2: 25
^ Amendment (explain in comment section)
Date of Original Filing: 06/25/09
(month, day, year)
^ Individual Q Other Rough-Fit, INC
Last Name First Name Name
12402 Browning Ave Santa Ana CA 92705
Address City State Zip Code
Fitness Instructor
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:
Rough-Fit, INC $ 75.00 $
Name Amount Name Amount
3. Payment Information
Date and Amount of Payment (ornerrnan travel) 05/12/09 $ 75.00
(month, day, year) (Round to whole dollars)
Travel Payment Information (Round to whole douars) 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:
Sponsorship for Movies in the Park 2009
Identify the officials for whom the payment was used:
N/A
Last Name First Name
Last Name First Name
Title
Title
DepartmenUDivision
DepartmenUDivision
4. Verification
1 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.
Signature Age y Head or Designee Print Name Title ( onth, day, year)
Comment: (Use this space or an attachment for any additional information.)
FPPC Form 801 (June/OS)
FPPC Toll-Free Helpline: 866/ASK-FPPC (866/275-3772)