HomeMy WebLinkAboutDr. Laila NayabGift to Agency Repc
1. Agency Name
City of Tustin
Division, Department, or F
Parks & Recreation
Street Address
300 Centennial Way
Area Code/Phone Numbet
714-573-3326
Agency Contact (name and
Carrie Woodward
A Public Document
cwoodward@tustinca.org
TO AGENCY REPORT
MAY 0 4
TUSTIN
CITY CLERK'S (
❑ Amendment (explain in comment section)
Date of Original Filing:
(month, day, year)
uonor Name ana Aaaress
❑ Individual ❑x Other Dr. Laila Nayab, Chiropractor
Last Name First Name Name
210 W. Mail St. St. 104 Tustin Ca 92780
Address City State Zip Code
Chiropractor
If "Otheris marked, describe the entity's business activity (if busm set or its nature and interests.
If applicable, identify the name of each source anu litre amounts) solicited or received by the donor for this gift:
Dr. Laila Nayab, Chiropractor $ ;50.00 $
N,),,• Amount Name Amount
3. Payment Infurrnation �a
Date and Amount of Payment (other than travel) 5 $ `/SD' Oy
(month, dey, 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 $ -royal Expenses
Provide a specific description of the nature and use of the payment for official agency business:
Identify the officials for whom the payment was used:
Last Name First Name
Department/Division
Last Name First Name Title Department/Division
4. Verification
I have determined that it is in the inter s of the agency to accept this gift and use it for the official agency business described above.
Day
vWWWcl Rflt-(ffid 51�
Signature ofAgency Head or Designee Print Name Title (month, day, year)
Comment: (Use this space or an attachment for any additional information.)
FPPC Form 601 (June/08)
FPPC Toll -Free Helpline: 866/ASK-FPPC (8661275.3772)