HomeMy WebLinkAboutYOGURT GROUP LLCGift to Agency Report
1. Agency Name
Divisio ,Department, or Region (if applicable)
Street Address
3oc~ C~~rnn~r~~ ~ Tust~
Area Code/Phone Number E-mail
~~It-1-573 -- 33a..(C
Agency Contact (name and title)
2. Donor Name and Address
A Public Document GIFT TO AGENCY REPORT
Date Stamp • e '
CITY OF TUSTlN For Official Use Only
09 SEP - I A !I~ U
~~o
^ Amendment (explain in comment section)
Date of Original Filing:
(month, day, year)
^ Individual Other `~l~~r+ %`~~ ~J
Last Name First Name ( 1 N e
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
~y ~o
Date and Amount Of Payment (other than travel) v l1 ~ $ ~~ 000.
(m nth, iay, year) (Round to whole dollars)
Travel Payment Information (Round to whore doirars) 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:
Identify the officials for whom the payment was used:
Last Name First Name
Title
DepartmenUDivision
Last Name First Name Title 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.
C~~u,~'f,~ ~~~P~° ~~~h~ ~ C'1e~e.1 ~.~~f ~~~i(tn S~ ~t-wsc~ 8 a ~ o
Signature of Agency Head or Designee 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)