HomeMy WebLinkAboutEMS Development CompanyGift to Agency Report
1. Agency Name
City of Tustin
Division, Department or Region (ifappiicabi
Police Department
Street Address
300 Centennial Way, Tustin, CA 92780
A Public Document
(714) 573 -3300 1saftken@tustinca.org
Shannon Aitken Executive Secretary
)onor Name and Address
❑ Individual
Last Name First Name
GIFT TO AGENCY REPORT
For Official Use Only
NOV 12 2014
TUSTIN
CITY CLERK'S OFFICE
❑ Amendment (explain in corranent sedbn)
Date of Original Filing:
(month. day, ye9r)
® Other EMS Development Company
Name
14081 S. Yorba Street, Suite 107 Tustin CA 92780 -2050
Address city state Zip Code
Shopping Center
If'Othef Is marked, describe the mays 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 Among
3. Payment Information
Date and Amount of Payment (otherthen travep 11/06/2014 $ 200.00
(month. day, year) (Round to whole dollars)
Travel Payment Information (Round to whole daiars) Location of Travel
Dates) of Travel Transponetbn Expenses $ Lodging Expanses $ Meal Expenses 79W $ F_cpenses $ Total Expenses
Provide a specific description of the nature and use of the payment for official agency business:
Donation to the Tustin Police Department Santa Cop Program
Identify the officials for whom the payment was used:
Last Name First Name Title Dsparnnent/DMslon
Last Name Frst Name Title DepartmenMvislon
4. Verification
I v ermin Is in the Interests of the agency to accept this giR and use it for the official agency business described above.
craven Acting Chief of Police 11/06/2014
S53 of or Designee Pont Name Title (month, day. year)
Comment: (Use this space or an attachment for any additional information.)
FPPC Forrn 801 (Juna,M)
FPPC Toll -Free Helpllne: 8661ASK -FPPC (866!276.3772)