HomeMy WebLinkAboutDOCTOR'S AMBULANCE SERVICEGift to Agency Report
1. Agency Name
Tustin Police Department
Division, Department, or Region (iiapplicable)
Community Policing Trust Fund
300 Centennial Way, Tustin, CA 92780
A Public Document
(714) 573-3300 ~ saitken@tustinca.org
Agency Contact (name and title)
Chief Scott Jordan or Shannon Aitken
2. Donor Name and Address
^ Individual ^x Other Doctor's Ambulance Service
Last Name First Name Name
23091 Terra Drive Laguna Hills CA 92653
Address City State Zip Gdde
Ambulance Service
If "Ottrer" 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
GIFT TO AGENCY REPORT
For Official Use Only
Amount
3. Payment Information
Date and Amount of Payment (other than travel) 01-31-2011 ~ 2,500.00
(month, day, year) (Round to whole dollars)
Travel Payment Information (Round to whore aorlars) 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:
Community Policing Trust Fund -Annual Report
Identify the officials for whom the payment was used:
Last Name
First Name
Last Name First Name
Date Stamp
~ p43
^ Amendment (explain in comment section)
Date of Original Filing:
(month, day, year)
Title
Title
DepartmentfDivision
DepartmentlDivision
4. Verification
t have determined that it is in the interests of the agency fo accept this gift and use it for the otficia( agency business described above.
Scott M. Jordan Chief of Police
Signature of Agency Head 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 Nelpline: 866/ASK-FPPC (866/275-3772)