HomeMy WebLinkAboutPEERY DONNAGift to Agency Report
1. Agency Name
City of Tustin
Division, Department, or Region (ifappiicabte)
300 Centennial Way
Street Address
Tustin, CA 92780
lrea Code/Phone iVu
(714) 573-3107 cshingleton@tustinca.org
Agency Contact (name and title) Date of Original Filing:
(month, day, year)
Christine Shingleton
2. Donor Name and Address
x^ Individual PEERY DONNA ^ Other
Last Name First Name Name
Tustin CA 92780
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:
Donna Peery ~ 800.00
Name Amount
Date Stamp
Name
GIFT TO AGENCY REPORT
For Official Use Only
Amount
3. Payment Information
Date and Amount of Payment (other than travar)
(month, day year) (Round to whole dollars)
Travel Payment informatlOn (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:
Last Name First Name Title
Last Name First Name Title
Department!Division
DepartmenUDivision
4. Verification
I have determined that it is in the interests of tl~e agency to accept this gift and use it for the official agency business described above.
l~G~~~""~~~ ____ Christine Shingleton Assistant City Manager
Signature of Agency Hea Designee Print Name Title
Comment: (Use this space or an attachment for any addltiona/ information.)
12/3/2008
(month; day, year)
A Public Document
^ Amendment (explain in comment section)
FPPC Form 801 {JunetOBy
FPPC Toll-Free Helpline: 866/ASK-FPPC {866!275-3772)