HomeMy WebLinkAboutElder Center Merchants AssociationGift to Aqency Report A Public Document GIFT TO AGENCY REPORT
%gency Name
City of Tustin
Police Department
300 Centennial Way, Tustin, CA 92780
(714) 573-3300 1 saitken@tustinca.org
Shannon Aitken Executive Secretary
2. Donor Name
❑ Individual
Last Name First Name
Date Stamp
CITY OF TUSTI
i DEC -4 P 4:
01
For Official Use Only
❑ Amendment (explain in comment section)
Date of Original Filing:
(month, day, year)
❑X Other Enderle Center Merchants Association
14081 S. Yorba Street, Suite 107 Tustin CA 92780-2050
Address city State Zip Code
Shopping Center
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:
$ $
Amount Name Amount
3. Payment Information
Date and Amount of Payment (other than havel) 11/15/2012 $ 200.00
(month, day, year) (Round to whole dollars)
Travel Payment Information (Round rowhole dollars) Location of Travel
Dates) of Travel Transportation Expenses $ Lodging Expenses $—P .7. TIExpenses $ Other Expenses $ Total Expanses
Provide a specific description of the nature and use of the payment for official agency business:
Donation to the Tustin Police Department Santa Sleigh Program
Identify the officials for whom the payment was used:
Last Name F,n( Name Title Department/Division
Last Name First Name Title 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.
4,1 J0r61&0 Ch;efofall'a
Signature of Ag y Head or Designee Print Name Title (monm, day, year)
Comment: ( se this space or an attachment for any additional information.)
FPPC Form 801 (June108)
FPPC Toll -Free Helpline: 866/ASK-FPPC (8661275-3772)