HomeMy WebLinkAboutSIEGEL, JEANNEGift to Agency Report A Public Document GIFT TO AGENCY REPORT
. Agency Nan
City of Tustin
or Region (ifapplicab/e)
300 Centennial Way, Tustin, CA 92780
(714) 573-3000 I cshingleton@tustinca.org
agency Contact (name and title)
Christine Shingleton, Assistant City Manager
2. Donor Name and Address
(month, day, year)
^x Individual Siegel Jeanne ^ Other
Last Name First Name Name
P.O. Box 332 Tustin CA 92781
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 (ornerman traveq
12/1 /2010
(month, day, year)
Date Stamp
For Official Use Only
^ Amendment (explain in comment section)
Date of Original Filing:
$ $400.00
(Round to whole dollars)
Travel Payment Information (Round to whole donor;) 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 Department/Division
Last Name First Name Title Department/Division
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.
Christine Shingleton Assistant City Manager 12/1/2010
Signa ure of gency He or Designee 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 (8661275-3772)