HomeMy WebLinkAboutLA TOURETTE, KENGift to Agency Report
1. Agency Name
City of Tustin -Parks and Recreation
or Region (if
300 Centennial Way Tustin, CA 92780
itreet Address
(714) 573-3326
area CodetPhane Numbe
Sarah King
-gency Contact (name anc
Recreation Coordinator
A Public Document
sking@tustinca.org
2. Donor Name and Address
{month, day year)
Q Individual La Tourette Ken Other
Last Name First Name ~ Name
Tustin CA 92780
Address City State Zip Code
Sponsorship for Summer Concerts in the Park
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 ar received by the donor far this gift:
Name ~ Amount Name ~ Amount
3. Payment Information
Date and Amount of Payment (otnertnan travel)
06/06/2011
(montn, day year)
~ 438.00
(Round to w~nole dollars)
Travel Payment Information {Round to wnore dollars) t_OCation of Travel
Dates} of Travel Transportation Expenses ~ Lodging Expenses ~ Meal Expenses ~ Other Expenses ~ Total Expenses
Provide a specific description of the nature and use of the payment far official agency business:
Identify the officials for whom the payment was used:
Last Name First Name Title DepartmenUDivision
Last Name First Name Title DepartmenUDivision
4. Verification
( 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?
3 - .:, _
~°^ Signature of Ay-rcy„ d or Designee Print Name Title (month. d<• ,year)
Comment: (Use this space or an attachment for any addrtrona( information.)
Date Stamp
r ~,,
GIFT TO AGENCY REPORT
For Official Use Only
Amendment {exptain in comment section}
Date of Original Filing:
FPPC Form 801 (June/08)
FPPC Toll-Free Helptine: 866/ASK-FPPC {866/275-3772}