HomeMy WebLinkAboutBEACH PIT BBQGift to Agency Report
1. Agency Name
Divisio ,Department, or Region (if applicable)
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Agency Contact (name and title)
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2. Donor Name and Address
Date Stam
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GIFT TO AGENCY REPORT
For Official Use Only
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^ Amendment (explain in comment section)
Date of Original Filing:
(month, day, yeah
^ Individual _ Other i--~,~ `~{~(~~ JY t~tC-~-, L~--~
Last Na a First name l _ y Name
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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
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Date and Amount Of Payment (other than travel) I ~ ~ C ~ $ ~ ~ ~ d DD . °~'
(mo th, y, 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:
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ast Name First Name Title DepartmenUDivision
Last Name First Name Title
DepartmenUDivision
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 Agency Head or Designee Print Name Title (month, day, year)
Comment: (Use this space or an attachment for any additional information.)
A Public Document
FPPC Form 801 (June108)
FPPC Toll-Free Helpline: 8661ASK-FPPC (8661275-3772)
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COMPANY NAME:
SPONSOR LEVEUAMOUNT: II~C~C~
CONTACT PERSON: _ 1\1 ~C~. < < V -~'I~ I~ ~ ~1
ADDRESS:
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Please return this form with your donation to:
City of Tustin, Tustin Tiller Day Committee
Attn: Christine Cleveland
300 Centennial Way
Tustin, CA 92780
Make checks payable to City of Tustin.
Please email company artwork in JPEG, GIF or TIFF format to ~~cs~vr.ianriia~tu~#ir~ca.=.;r~
DEADL/NE FOR ARTWORK /S Au4ust 18 2008
SPONSORSHIP RESPONSE FORM
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