HomeMy WebLinkAboutDAVERT, ANNGift to Agency Report
1. Agency Name
City of Tustin
Division, Department, or Region
Library Fund
Street Address
300 Centennial Way
A Public Document
Area Code/Phone Number E-mail
^ Amendment (explain in comment section)
(714) 573-3010
Agency Contact (name and title) Date of Original Filing:
(month, day, year)
Christine Shingleton, Assistant City Manager
2. Donor Name and Address
^x Individual Davert Ann ^ Other
Last Name First Name Name
Santa Ana CA 92705
Address Gity 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:
Ann P. Davert $ 400.00 $
Name Amount Name Amount
3. Payment Information
Date and Amount of Payment (other than travel) $
(month, day year} (Round to ia~hote doilars}
Travel Payment Information {Round ro whole dollars) Location of Travel
Date(sl 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
Last Name First Name
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Title
Title
DepartmenUDivision
4. Verification
1 have determined that it is in the interesfs of the agency to accept this gift and use it for the official agency business described above.
1
Christine Shingleton Assistant City Manager 11/14/08
Signature of Agency Head or Des' ee Print Name Title (month. day, year)
COCYIment: (Use this space or an attachment for any additional informafion.)
Donation -Library Fund
GIFT TO AGEFlCY REPORT
~ For Official Use Only
DepartmentlDivision
FPPC Form 801 (June/OS}
FPPC Toll-Free Helpline: 866/ASK-FPPC (8661275-3772)