HomeMy WebLinkAboutSports Clips (3) Gift to Agency Report A Public Document GIFT TO AGENCY REPORT
1.Agency Name [!CET3 v Foorn rm a 801
City of Tustin
Division, Department,or Region (if applicable) For Official Use Only
Parks& Recreation Dept. SEP 3 2015
Street Address TUSTIN
300 Centennial Way, Tustin, Ca. 92780 CITY CLERK'S OFFICE
Area Code/Phone Number E-mail
0 Amendment(explain in comment section)
714-573-3326 cwoodward@tustinca.org
Agency Contact(name and title) Date of Original Filing:
(month,day.year)
Carrie Woodward, Rec. Coordinator
2. Donor Name and Address
❑Individual ❑x Other Sports Clips the District
Last Name First Name Name
22 Eclipse Irvine Ca 92620
Address City State Zip Code
Business-Sponsorship payment
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:
Sports Clips $ 1,400.00
Name Amount $
Name Amount
3. Payment Information
Date and Amount of Payment(other than travel) $
(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 Title Department/Division
Last Name First Name Title Department/Division
4. Verification
I 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.
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Signature of C(gency 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)