HomeMy WebLinkAboutROBERTS, TODDGift to Agency Report A Public Document GIFT TO AGENCY REPORT
City of Tustin
)ivision, Department, or Region (rf applicable)
Parks and Recreation
CITY OF ~~~ ~t~p
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For Official Use Ony
300 Centennial Way Tustin, CA 92780
(714) 573-3333 ~ sking@tustinca.org
^ Amendment (explain in comment section)
Data of Original Filing:
(month, daY Yid
2.
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:
~~ Name $ mount Name $ Amount
3. Payment Information
Date and Amount of Payment (ornarrnan bavaq ~ ~ ~~ $ ~•
(moo , da year) ( and to whole dollars)
Travel ayment Information (Round to whore da-ars) Location of Travel
$ ~ $ $
te( ) of Travel ransportation Expenses Lodging Expenses Meai Expenses Other Expenses Total Expenses
Provi e a specific description of the nature and use of the payment for official agency business:
Identify the officials for whom the payment was used:
N/A
Last Name First Name Tdle DepartmenUDivision
Last Name First Name Title
DepartmenUDivision
4. Verification
1 have d ermine 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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ature of ncy H ad or Designee riot Na Title (m th, ay, year)
Comment: (Use this space or an attachment for any additional information.)
FPPC Form 801 (June/08)
FPPC Toll-Free Helpline: 866/ASK-FPPC (866/275-3772)
Sarah King, Recreation Coordinator ~ ~