Loading...
HomeMy WebLinkAboutKIWANIS CLUB OF TUSTINGift to Agency Report . Agency Name City of Tustin or (if app/icab/e) A Public Document GIFT TO AGENCY REPORT Date Stamp • • , t-~ t ~./ • 1. i ~ t ~ ~ ~ ~ ~ ~ ' For Official Use Only Police Department itreet Address 300 Centennial Way area Code/Phone Nun 714 573-3396 rortiz@tustinca.org Agency Contact (name and title) Ruby Ortiz :Police Services Officer 2. Donor Name and Address zad~ ~Ar~ ~ $ ~ ~# ss ^ Amendment (explain in comment section) Date of ONginal Filing: (month, day, year) ^ Individual Other Kiwanis Club of Tustin Last Name First Name © Name P.O. BOX 514 Tustin CA 92781 Address City State Zip Code If "Other" is marked, describe the entity's business activity (it 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: Kiwanis Club of Tustin Name $ $400.00 Amount Name Amount 3. Payment Information Date and Amount Of Payment (other than travel) $ (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: Funds were used for the Santa Cop Program. Identify the officials for whom the payment was used: Last Name First Name Title DepartmenUDivision 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. ~~~~ ~~'~ , ~ ~ Scott M. Jordan Chief of POlice 1-5-11 Signature of Agen Head or Designee Print Name Tdle (month, day, year) Comment: (Use this space or an attachment for any additional information.) FPPC Form 801 (June/08) FPPC Toll-Free Helpllne: 866/ASK-FPPC (886/275-3772)