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Tickets Provided by <br />Aciencv Report <br />City of Riverside <br />or Region (if <br />Development Dept. <br />>treet Address <br />3900 Main St., Riverside, CA 92522 <br />951-826-5769 <br />(name and title) <br />Pamela Hogan <br />2. Event For Which Tickets Were Distributed <br />❑ Amendment (Must expiain in Part 5.) <br />Date of Original Filing: <br />(month, day, year) <br />Date(s) of Event: 10 Description of Event: Hairspray Play at Fox Performing Arts Center <br />04 l 25 1 10 Face Value of Tirket• 79.00 <br />Agency Event 0 Yes ❑ No (Identify source of tickets below.) <br />Name of Outside Source of Ticket(s) Provided to Agency. <br />Number of Tickets Received: <br />A Public Document TICKETS PROVIDED BY <br />AGENCY REPORT <br />cEr T. ~ ~ ~ • ~ <br />t ,5^SJ <br />rh A 201 t~ For Official Use Only <br />FFt4~I L3: \ i i F <br />Ticket(s) Provided to Agency: El 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 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: Number of Tickets: <br />Description of Organization: <br />Address of Organization: <br />Number and Street city State Zip Code <br />Purpose for Distribution: (Describe the public purpose for the distribution to the organization.) <br />5. Verification <br />1 e determined that the distribution of tickets set forth above is in accordance with the provisions of FPPC Regulation 18944.1. <br />Deanna Larson Director <br />Signature of Agency Head or Designee Print Name Title <br />(month, day, year) <br />Comment: (Use this space or an attachment for any additional information including amendment explanation.) <br />FPPC Form 802 (Feb/09) <br />FPPC Toll-Free Welpline: 8661ASK-FPPC (8661275-3772) <br />