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HomeMy WebLinkAboutSTARBUCKSGift to Agency Report 1. Agency Name City of Tustin Division, Department, or Regi Police Department Street Address 300 Centennial way Area CadelPhone Number 714-573-3306 Agency Contact {name and title) Penni Foley A Public Document Date Scamp GIFT TO AGENCY REPORT For Official Use Only pfoley@tustinca.org ^ Amendment (explain in comment section) Date of Original Filing: (month, day, year) 2. Donor Name and Address ^ Individual ~ Other Starbucks Last Name First Name Name 552 E. First Street Tustin CA 92780 Address City State Zip Code Cofree shop 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: Name ~ Amount Name $ Amount 3. Payment fnfarmation Date and AmOUnt Of Payment (other than travel) 11-30-2011 (month, day, year) $ 50.00 (Round to whole dollars) Travel Payment Information (Round to whore aouarsJ 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: Desserts valued at approximately $50.00 were donated to the Police Department to be shared by employees and visitors. Identify the officials for whom the payment was used: Last Name First Name Title Department/Division Last Name First Name Title DepartmentlDivision 4. Verification f have determined That it is in the interests of the agency to accepf this gift and use it for flee official agency business described above. Scott M. Jordan Chief of Police 12-1-2011 Signature of Agencp Fieaa or Designee Print Name Title (month, day, year) C©mment: (Use this space or an attachment for any additional information.) FPPC Form 841 {June/08) FPPC Toll-Free Helpiine: 866/ASK-FPPC (86&/275-3772)