HomeMy WebLinkAboutGO BANANAZGift to Agency Report
1. Agency Name
City of Tustin
on, Department, or Region (if
Parks and Recreation
300 Centennial Way
area Code/Phone Num
(714) 573-3326
(name and title)
A Public Document
SKing@tustinca.org
Date Stamp
GIFT TO AGENCY REPORT
For Official Use Only
^ Amendment ('explain in comment section)
Date of Original Filing:
(month, day, year)
Sarah King, Recreation Coordinator
2. Donor Name and Address
^ Individual ~ Other Go Bananaz
Last Name First Name Name
1084 Irvine Boulevard Tustin CA 92780
Address City State Zip Code
If "Other" is marked, describe the entity's business activity (ii business) oats 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
Date and Amount of Payment (otnertnan o-avel) 7/1/2010 ~ 75.00
(month, day, year) (Round to whole dollars)
Travel Payment Information (Round ro wno~e aouars) 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 2010 Movies in the Park
Identify the officials for whom the payment was used:
Name
First Name Title
DepartmenUDivision
Last Name First Name Title DepartmenUDivision
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.
'~~~. Sarah King Recreation Coordinator 8/27/10
Signature of Agency H ado e ~gnee Print Name Title (month, day, year)
COCnrnent: (Use this space or an attachment for any additional information.)
FPPC Form 801 (June108)
FPPC Toll-Free Helpline: 866/ASK-FPPC (8661275-3772)