HomeMy WebLinkAboutKiwanis Club of Tustin Gift to Agency Report A Public Document GIFT TO AGENCY REPORT
1.Agency Name Date Stamp a i ornla Q O 1
City of Tustin i i r�Y1_iv Form v
Division,Department,or Region(if applicable) �= — For Official Use Only
Tustin Police Department OCT 0 7 ?013
Street Address
300 Centennial Way, Tustin, CA 92780 tiff:€€:11,1P fifi'@VP k
Area CodelPhone Number "E-mail
❑ Amendment(explain in comment section)
714-573-3300 slewis @tustinca.org
Agency Contact Iname and title) Date of Original Filing:
(month.day.year)
Stephen D. Lewis, Captain
2. Donor Name and Address
0 D Other Kiwanis Club of Tustin
Last Name First Name Name
P.O. Box 514 Tustin CA 92781-5124
Address City State Zip Code
Non-profit
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) 9-30-13 $ 200.00
(month,day,year) (Round to whole dollars)
Travel Payment Information(Round to whole dollars) 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 Tide Department/Division
Last Name First Name Title DepamnentDivision
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.
Charles F. Celano, Jr. Interim Chief of Police 10/03/2013
Signature of Age ead or Desig 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(8681275.3172)