HomeMy WebLinkAboutRITZ NAILSGift to Agency Report A Public Document GIFT TO AGENCY REPORT
1. Agency Name D st ? • • '
rtes '
Division, partment, or Region (ifapp/icab/e) Z ~~R ~?rj _ ~ ~} (2: ~ For Official Use Only
- - - . . ~
rnvne r~unrua~ c-u~au ^ Amendment (explain in comment section)
13- n
intact (name and title) Date of Original FIIIng:
i n ~ ~ n _ _ (month, day, year)
2. Donor Name and Address
^ Individual
Last Name
Address
Zip Code
Ii "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:
52.Oa
Name ~ Amount Name ~ Amount
3. Payment Information
Date and Amount of Payment (otherrnan rrs~el) $
(month, day, year) (Round to whole dollars)
Travel Payment Information (Round to whore dolars) 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:
fur ~ 13 ~ rnan icur~ cer~i~i cakg received ~Or Grh~'s Nca I+h ~a~r.
Identify the officials for whom the payment was used:
Last Name First Name
Last Name First Name
(J Other w
rtle
Title
DepartmenUDivision
DepartmenUDivision
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.
) y; ~~ Kris- ~cchi a Direehr,Human ~s6urces ~Q/3 ~~
Si n lure 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)
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