HomeMy WebLinkAboutBROUGH, WENDYGift to Agency Report A Public Document GIFT TO AGENCY REPORT
City of Tustin
or Region (if appticabte)
itreet Address
300 Centennial Way, Tustin, CA 92780
area Code/Phone Number E-mail
(714) 573-3010 cshingleton@tustinca.org
Agency Contact (name and title) date of Original Filing:
{month, day, year)
Christine Shingleton, Assistant City Manager
2. Donor Name and Address
^x Individual Brough Wendy ~ 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:
Same as above
Name
~ 400.00 ~
Amount Name Amount
3. Payment Information
Date and Amount Of Payment (other than travel)
{month, day year) (Round to whole doitars)
Travel Payment Information {Round townotedonors) 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
Cl~i~~~ O~a'~~Ir~
FED -3 ~ 4~ 3
Title
For Official Use Only
DepartmentlDivision
DepartmenUDivision
4. Verification
have determined That it is in the interests of fhe agency to accept this gift and use it for the officio( agency business described above.
,_'Z~~~:l~ Christine Shingleton Assistant City Manager
Signature of Age y ead or Designee Print Name. Title
Comment: ( this space or an attachrrrent for arry additional information.)
Amendment {explain in comment section)
2/2/09
(month, day, year)
FPPC Form 801 (June108)
FPPC Toli-Free Heipiine: 866/ASK-FPPC (8661275-3772)