Loading...
HomeMy WebLinkAboutEICHINGER, DCGift to Agency Report A Public Document GIFrTOAGENCYREPORT agency Name City of Tustin Police Department >treet Address 300 Centennial Way 714 573-3396 Date Stamp or Region (if applicable) rortiz@tustinca.org Agency Contact (name and title) Ruby Ortiz :Police Services Officer 2. Donor Name and Address '~~iY ~~ ~(~S~1N For Official Use Only Amendment (explain in comment section) Date of Orlglnal Filing: (month, day, year) © Individual Eichinger D.C. ~ Other Last Name First Name Name 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: D.C. Eichinger $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 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. i /~ ` ~~~ Z~~~r ~ < Scott M. Jordan Signature of Ag cY Head or Designee Print Name Comment: (Use this space or an attachment for any additional information.) Chief of Police rtie 1-5-11 (month, day, year) FPPC Form 801 (June/08) FPPC Toll-Free Helpllne: 866/ASK-FPPC (866/275-3772)