HomeMy WebLinkAboutSIERRA NEVADA BREWING COMPANYGift to Agency Report
1. Agency Name
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Divan. Department. or Rea
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Agency Contact (name and title)
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2. Donor Name and Address
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^ Individual Other
Last Name First Name
Date Stamp
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GIFT TO AGENCY REPORT
For Official Use Only
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Amendment (explain in commentGsection)
Date of Original Filing: I i~ ~ 0 ~ G't~
(month, day, year)
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If "Other" is marked, d~scribe the ehtity's bus n~ss 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
Date and Amount of Payment (other than travel) ~~ ~ Q~ $ ~, ~~d ~ u~,.
(monl ,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:
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Last Name First Name Title DepartmenUDivision
Last Name First Name Title DepartmenUDivision
4. Verlflcatlon
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 (mon , da ,year)
Comment: (Use this space or an attachment for any additional information.)
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A Public Document
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FPPC Form 801 (June/08)
FPPC Toll-Free Helpline: 866/ASK-FPPC (866/275-3772)
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