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HomeMy WebLinkAboutDROUIN REALTY INCGift to Agency Re 1. Agency Name City of Tustin or Police Department 300 Centennial Way \rea Code/Phone Nun 714 573-3396 (name and title) rortiz@tustinca.org Ruby Ortiz :Police Services Officer 2. Donor Name and Address A Public Document Date Stamp GIFT TO AGENCY REPORT i ~ ~ i ~ `~ t i ~ For Official Use Only JAN ! 8 A 9~ 5 S ^ Amendment (explain in comment section) Date of Original Filing: (month, day, year) ^ Individual Other Drouin Realty inc. Last Name First Name © Name 14081 Yorba Street Tustin CA 92780 Address City State Zip Code If "Other' is marked, describe the entity's business activity (if 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: Drouin Realty Inc. $ $200.00 Name Amount Name Amount 3. Payment Information Date and Amount of Payment (ornerrnan 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 Last Name First Name Title DepartmenUDivision DepartmenUDivision 4. Verification 1 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. ti/~~~ ~~ ~ ~~ Scott M. Jordan Chief of Police 1-5-11 Signature of Ag ' cy Head 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)