HomeMy WebLinkAboutENDERLE CENTER MERCHANTS ASSOCIATIONGift to Agency Report A Public Document
1. Agency Name
City of Tustin
Division, Department, or Region (if applicable)
Police Department -Santa Sleigh Program
300 Centennial Way
trea Code/Phone Number
714-573-3285
agency Contact (name and title)
dhavourd@tustinca.org
George Vallevieni
2. Donor Name and Address
Date Stamp
'v ! i i.~ f
GIFT TO AGENCY REPORT
For Offiaal Use Only
200 Gov ~ q I ~ 1 ~ : ~ ~
^ Amendment (explain in comment section)
Date of Original Filing:
(month, day, year)
^ Individual Q Other Enderle Center Merchants Association
Last Name First Name Name
14081 S. Yorba St.; Suite 107 Tustin CA 92780-2050
Address City State Zip Code
Merchants' Asociation
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 ~ 200.00
Name Amount
Name
Amount
3. Payment Information
Date and Amount of Payment (ornerrhan travel) $
(month, day, year) (Round fo whole dollars)
Travel Payment Information (Round to whole dorars) 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
Last
First 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.
--=~~~ ~~ Scott M. Jordan Chief of Police 11-22-2010
Signature of gency a or Designee Print Name Title (month, 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)