HomeMy WebLinkAboutSports Clips (2)Gift to Agency Report A Public
City of Tustin
nrraron, ueparanent, or Regi
Parks and Recreation Dept.
300 Centennial Way, Tustin, Ca. 92780
714-573-3326 I cwDodward@tustinca.org
lgency Contact (name and title)
Carne Woodward, Recreation Coordinator
2. Donor Name and Address
❑ Individual
Lett Name Fiat None
22
for events
Irvine
ment
EP.11
MAY 2 7 2015
TUSTIN
CITY CLERK'S OFFICE
❑ Amendment (explain in comment sacwn)
REPORT
the ONy
Date of Original Filing:
(rtwnN, -dayY..,)
I@ Other Sports Clips
Nome
Ca 92620
If applicable, identify the name of each source and tha amounts) solicited or received by the donor for this gift:
Sports Clips 800.00
Name -
Amount
$
Anqunt Name Amount
3. Payment Information
Date and Amount of Payment (otherumn vave!) $
(manM, deg year) lRountl to whole dopers)
Travel Payment Information (Roandto whole dollars) Location of Travel
Dales)a TTrevel Trenaporteaon $Gldgmo _
Provide a specific description of the ature and use of the payment for official agency business:
Identify the officials for whom the payment was used:
Lest Name Flys! Name
Last Name First Name
Depa0"rVD VWW
••'� uepenmemlDihslon
4. Verification n
I have determined that it is in thle Interests of the agency to adept this gift and use it for the official agency business described above.
i
.o
Vow
natwe
Igof Agency Head or nee Prim em
role (month, day, year)
Comment: (Use this space or an attachment for any additional information.)
FPPC Form 801 (June/OB)
FPPC Toll -Free Helpline: 866/ASK-FPPC (866276-3772)