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Tickets Provided by <br />Agency Report A Public Document VCL~fl~TICKETS PROVIDED <br />AGENCY REPORT <br />RT <br />Agency Name <br />City of Riverside <br />Division, Department, or Region (if applicable) <br />Development Dept. <br />3900 Main St., Riverside, CA 92522 <br />951-826-5769 <br />(name <br />phogan @ riversideca.gov <br />Pamela Hogan <br />Date Stamp California 0,.i <br />For Official Use Only <br />❑ Amendment (Must explain in Part 5.) <br />Date of Original Filing: <br />(month, day, year) <br />2. Event For Which Tickets Were Distributed <br />Date(s) of Event: 05 107 1 10 Description of Event: Marx Bros. Performance at Fox Performing Arts Ctr. <br />-J Face Value of Ticket: $ 42.00 <br />Agency Event x❑ 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 />Bailey, Rusty <br />Davis, Paul <br />1 Promotion of City Profile <br />1 Promotion of City Profile <br />Hart, Nancy I 1 I 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 e determined that the distribution of tickets set forth above is in accordance with the provisions of FPPC Regulation 18944.1. AMA Deanna Lorson Director <br />Signature of Agency Head or Designee Print Name Title (month, day, year) <br />Comment: (Use this space or an attachment forany additional information including amendment explanation.) <br />Number of Tickets: <br />FPPC Form 802 (Feb/09) <br />FPPC Toll-Free Helpline: 866IA5K-FPPC (8661275-3772) <br />