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Tickets Provided by <br />Agency Report <br />1. Agency Name <br />City of Riverside <br />ulvision, uepartrnent, or Region (if applicable) <br />Development Dept. <br />Street Address <br />A Public Document <br />RRC <br />3900 Main St., Riverside, CA 92522 <br />951-826-5769 <br />(name and <br />phogan@riversideca.gov <br />Pamela Hogan <br />2. Event For Which Tickets Were Distributed <br />Date(s) of Event: 01 1 30 / 10 Description of Event: Benise Concert at Fox Performing Arts Center <br />~J~ . Face Value of Ticket! $ <br />AY 2 4 2G10 <br />,M <br />TICKETS PROVIDED BY <br />AGENCY REPORT <br />For Official Use only <br />❑ Amendment (Must explain in Parr 5,) <br />Date of Original Filing: <br />(month, day, year) <br />61.00 <br />Agency Event ❑ Yes ❑ No (Identify source of tickets below.) <br />Name of Outside Source of Ticket(s) Provided to Agency: <br />Number of Tickets Received: Ticket(s) Provided to Agency: Q Gratuitously ❑ Pursuant to Contract <br />3. Agency Official(s) Receiving Ticket(s) (use a continuation sheet for additional names) <br />Name of Official Number State Whether the Distribution is Income to the Official or <br />(Last, First) of Tickets Describe the Public Purpose for the Distribution <br />See Attached List <br />4. Individual or Organization Receiving Ticket(S) (Provided at the behest of an agency official.) <br />Name of Behesting Agency Official: <br />Name of Individual or Organization: <br />Description of Organization: <br />Address of Organization: <br />Number and Street <br />city <br />Purpose for Distribution: (Describe the public purpose for the distribution to the organization.) <br />State Zip code <br />5. Verification <br />t ve determined that the distribution of tickets set forth above is in accordance with the provisions of FPPC Regulation 18944.1. <br />Deanna Lorson Director <br />ignature of Agency Head or Designee Print Name Title (month, day, year) <br />Comment: (Use this space or an attachment for any additional information including amendment explanation.) <br />Number of Tickets: <br />FPPC Form 802 (Feb/08) <br />FPPC Toll-Free kelpline: 866/ASK•FPPC (8661276-3772) <br />