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HomeMy WebLinkAboutNISSENSON, LENARDGift to Agency Report A Public Document GIFfTOAGENCYREPORT '' ^y""'!r 1°"'a Date Stamp • w • City of Tustin ~~ ~ a~ ~~~~~~ • Division, Department, or Region (if applicable) For Official Use Only Police Department ~~~ ~ 8 ~ ~. 5 ~ Street Address 300 Centennial Way Area Code/Phone Number E-mail Amendment (explain in comment section) 714 573-3396 rortiz@tustinca.org Agency Contact (name and title) ~ Date of Original Flling: (month, day, year) Ruby Ortiz :Police Services Officer 2. Donor Name and Address © Individual Nissenson Lenard ~ Other Last Name First Name Name Orange CA 92867 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: Lenard Nissenson $ $100.00 $ Name 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 Last Name First Name Title Department/Division DepartmenUDivision 4. Verification 1 have determined that it is in the interests of the agency fo accept this gift and use it for the ofFcial agency business described above. (f '~, ~~ ~ ~ ~ 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: 866IASK-FPPC (8661275-3772)