HomeMy WebLinkAboutTRIFYTT SPORTSGift to Agern
1. Agency Nan
City of Tustin
A Public Document
Division, Department, or Region (if applicable) I
Parks and Recreation
300 Centennial Way Tustin, CA 92780
(714) 573-3333 I sking@tustinca.org
lgency Contact (name and title)
Sarah King, Recreation Coordinator
2. Donor Name and Address
^ Individual
Last Name First Name ~~
Address
If "Other" is marked, describe the entity's business activity (if business) or its nature
State
If ap licable, identify the name of each source and the amount(s) solicited or received by the donor for this gift:
Name ~ mount Name $ Amount
3. Payment Information
Date and Amount of Payment (ornerrnan travel)
c~ $ ~~.
day, ear) (Round to whole dollars)
Travel Payment Information (Round to whole douars) Location of Travel
l~' ~ $ $ $ $
Da e(s) of Travel ransportation 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:
N/A
Last Name First Name
CP`~r~ TUS
1009 JUL ! S A
GIFT TO AGENCY REPORT
For Official Use Only
rJS
Amendment (explain in comment section)
Date of Original Filing:
(month, day, year)
Other ~'~~
_ Name _
Title
Last Name First Name Title
DepartmenUDivision
DepartmenUDivision
4. Verification
1 have d rmined that it ' in the interests of the agency to accept this gift and use it for the official agency business described above.
. I
~ ~h ~
i ature ofAg cy d or Desig a Print Name Title (m nth, day, year)
Comment: (Use this space or an attachment for any additional information.)
FPPC Form 801 (June/08)
FPPC Toll-Free Helpline: 866/ASK-FPPC (866/275-3772)