HomeMy WebLinkAboutBUETOW, JULIAGift to Agency Report
1. Agency Name
City of Tustin
Division, Department, or Reg
300 Centennial Way, Tustin, CA 92780
A Public Document
(714) 573-3000 I cshingleton@tustinca.org
i,gency Contact (name and title)
Christine Shingleton, Assistant City Manager
2. Donor Name and Address
^x Individual Buetow Julia ^ Other
Last Name First Name Name
North Tustin CA 92705
Address City State Zip Code
If "Other is marked, describe the entity's business activity ('rf business) or its nature and interests.
It 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 travel) 12/1/2010 $ $800.00
(month, day, year) (Round to whole dollars)
Travel Payment Information (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
Last Name First Name
GIFT TO AGENCY REPORT
Date Stamp
For Official Use Only
^ Amendment (explain in comment section)
Date of Original Filing:
(month, day, year)
me
rtie
DepartmenUDivision
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.
ristine Shingleton Assistant City Manager 12/1/2010
Signature of Agency Head or esign Print Name Title (month, day, 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)