HomeMy WebLinkAboutBARRY, NANCYGift to Agency Report
1. Agency Name
City of Tustin
Division, Department, or Reg
Police Department
300 Centennial Way
714 573-3396
(name and title)
A Public Document
Date Stamp
CITY (fir T~~TI~
rortiz@tustinca.org
Ruby Ortiz :Police Services Officer
2. Donor Name and Address
Q Individual Barry Nancy
Last Name First Name
JAS (8 A 4 5 ~
^ Amendment (explain in comment section)
Date of Original Flling:
(month, day, year)
^ Other
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:
Nancy Barry $ $295.00
Name Amount
Name
GIFT TO AGENCY REPORT
Amount
3. Payment Information
Date and Amount of Payment (ornerrnan travel) $
(month, day, year) (Round to whole dollars)
Travel Payment Information (Round to whole dollar;) 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
Department/Division
Department/Division
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.
~~ ~ Scott M. Jordan
Signature of Ag cY Head or Designee Print Name
Comment: (Use this space or an attachment for any additional information.)
For Ofricial Use Only
Chief of Police
Title
1-5-11
(month, day, year)
FPPC Form 801 (June/08)
FPPC Toll-Free Helpllne: 866/ASK-FPPC (866/275-3772)