HomeMy WebLinkAboutFLAHERTY, PENNYGift to Agency Report A Public Document GIFT TO AGENCY REPORT
agency name
City of Tustin
or Region (if
Date Stamp
For Official Use Only
300 Centennial Way, Tustin, CA 92780
(714) 573-3000 ~ cshingleton@tustinca.org
tgenCy Contact (name and title)
Christine Shingleton, Assistant City Manager
^ Amendment (explain in comment section)
Date of Original Filing:
(month, day, year)
2. Donor Name and Address
^x Individual Flaherty Penny ^ Other
Last Name First Name
Name
Santa Ana CA 92705
Address City State Zip Code
If'Other" is marked, describe the entity's business activity ('rf 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 (ornerthan bevel) 12/1/2010 $ $400.00
(month, day, year) (Round to whole dollars)
Travel Payment Information (Round to whole dolars) 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 Tine DepartmenUDivision
Last Name First Name Title DepartmenUDivision
4. Verification
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.
C~~~~ Christine Shingleton Assistant City Manager 12/1/2010
Signature of Agency Head o esignee Print Name Title (month, day, year)
Comment: (Use this s ace or an attachment for any additional information.)
FPPC Form 801 (June/08)
FPPC Toll-Free Helpllne: 866/ASK-FPPC (866/275-3772)