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Tickets Provided by <br />jency Report A Public Document <br />ALgency Name <br />City of Riverside C <br />)ivision, Department, or Region (if applicable) MX 2C, I0 149 1 E Development Dept. <br />3treetAddress <br /> <br />3900 Main St., Riverside, CA 92522 <br />951-826-5769 phogan@riversideca.gov <br />Agency Contact (name and title) <br />Pamela Hogan <br />TICKETS PROVIDED BY <br />AGENCY REPORT <br />For Official Use Only <br />❑ Amendment (Must explain in Part 5.) <br />Date of Original Filing: <br />(month, daV near) <br />2. Event For Which Tickets Were Distributed <br />Date(s) of Event: 04 l 2 ) 10 Description of Event: Jesus Christ Superstar at Fox Performing Arts Center <br />Face Value of Ticket: $ 79.00 <br />Agency Event El 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: [E]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 />Gardner, Mike <br />1 Promotion of City Profile <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 />l h 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 />S3 nature 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/09) <br />FPPC Tall-Free Helpline: 8661ASK-FPPC (8661275-3772) <br />