HomeMy WebLinkAboutNoviello, JeffreyGift to Agency Report
A Public Document [,q[ErfPRM�n GIFT TO AGENCY REPORT
1. Agency Name
City of Tustin
Date Stamp
MAY 15 2012
• • '
For Official use only
Division, Department, or Region (if applicable)
Parks and Recreation
OFFICE - TUSTIN CITY CLE
Street Address
300 Centennial Way, Tustin, CA 92780
Area Code /Phone Number
E -mail
❑ Amendment (explain in comment section)
714 - 573 -3326
Dwilson @tustinca.org
Date of Original Filing:
(month, day, year)
Agency Contact (name and title)
David Wilson, Director Parks and Recreation
2. Donor Name and Address
❑
x Individual Noviello
Last Name
y ❑ Other
First Name
Name
Tustin CA 92780
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
Date and Amount of Payment (other than travel)
04/07/2012
(month, day, year)
Travel Payment Information (Round to whole dollars) Location of Travel
438.00
(Round to whole
$ $ $ $ $
Dale(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:
2012 Concerts in the Park Sponsorship
Identify the officials for whom the payment was used:
Last Name First Name Title Department/Division
Last Name First Name Title Department/Division
4. Verification
/ 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 5/14/12
Signature o0toincy 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 Helpline: 866 /ASK -FPPC (866/275 -3772)