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HomeMy WebLinkAboutDEVINE IMAGEGift to Agency Report A Public Document GIFT TO AGENCY REPORT agency Name City of Tustin Police Department itreet Address or Region (if applicable) 300 Centennial Way -rea Code/Phone Number E-ma 714-573-3306 I Pfoley@tustinca.org -gency Contact (name and title) Penni Foley, Administrative Secretary 2. Donor Name and Address zoos ocj 2 u For Official Use Only I~ 32 ^ Amendment (explain in comment section) Date of Original Filing: (month, day, year) ^ Individual Sarmiento Lieber (Owner) ^x Other Devine Image Last Name First Name Name 13132 Newport Avenue, Suite 200 Tustin CA 92780 Address City State Zip Code Business 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: Devine Image $ 300.00 Name Amount Name Amount 3. Payment Information Date and Amount of Payment (ornertnan ravel) $ (month, day, year) (Round to whole dollars) Travel Payment Information (Round to whole aorlars) Location of Travel Date(s) of Travel $ansportation 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: Four spa and skincare gift certificates, which were given as door prizes at the Neighborhood Watch Captains' Network meeting. Identify the officials for whom the payment was used: Four different residents of the community No City Officials received these gifts Last Name First Name Title Department/Division Last Name First Name Title Department/Division 4. Verification I have determined that if is in the interests of the agency to accept this gift and use it for the official agency business described above. ~_ Scott M. Jordan Signature of Agen ead or Designee Print Name Comment: (Use this space or an attachment for any additional information.) D~ ~~i"''~ F T Chief of Police rifle 10-23-08 (month, day, year) FPPC Form 801 (June/08) FPPC Toll-Free Helpline: 866/ASK-FPPC (8661275-3772)