HomeMy WebLinkAboutLANDRY'S MANAGEMENT LPGift to
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1. Agency Name
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Division. D oartment. or Re
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Aaencv Contact (name and
2. Donor Name and Address
GIFT TO AGENCY REPORT
For Official Use Only
^ Amendment (explain in comment section)
Date of Original Filing:
(month, day, year)
^ Individual ^ Other [~V~.r~~S ~~y~rn~2amp~v~' ~'~
Last Name First Name N e
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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:
$ $
Name Amount Name Amount
3. Payment Information
Date and Amount of Payment (otnerrnan travel)
(month, day, year) (Round to whole dollars)
Travel Payment Information (Round to whore donors) Location of Travel
Date(s) of Travel $ ansportation 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
DepartmenUDivision
Last Name First Name Title DepartmenUDivision
4. Verification
l 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.
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Signature of Agency Head or Designee Print Name Title ( anth, y, year)
Comment: (Use this space or an attachment for any additional information.)
A Public Document
Date Stamp
`~~`~ ~`~~~ ~ S Y OF TUSTIN
(if applicable)
SEP -1 A ll~ 4y
FPPC Form 801 (Junel08)
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