HomeMy WebLinkAboutSTOPHER, ROBERTGift to Agency Report
1. Agency Name
city of Tustin
Division, Deaartment. or Region
A Public Document
300 Centennial Way, Tustin, CA 92780
area CodetPhone Number E-mail
(714) 573-3000 cshingleton@tustinca.org
(name and title)
Christine Shingleton, Assistant City Manager
2. Donor Name and Address
Date Stamp
GIFT TO AGENCY REPORT
(month, day, year)
~ Individual Stopher Robert ~ Other
Last Name First Name Name
Tustin CA 92780
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 travel) 12/1/2010 $ $400.00
(month, day, year) (Round to whole dollars)
Travel Payment Information (Round to whole douar;) 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
Last Name First Name Title
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.
Christine Shingleton Assistant City Manager
Print Name Title
Comment: (Use this space or an attachment for any additional information.)
For Official Use Only
Amendment (explain in comment section)
Date of Original Filing:
12/1 /2010
(month, day, year)
FPPC Form 801 (June/08)
FPPC Toll-Eras Helpline: 866/ASK-FPPC (866/2753772)