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Tickets Provided by <br />Agency Report A Public Document TICKETS PROVIDED BY <br />AGENCY REPORT <br />1. Agency Name <br />ate Stamp <br />City of Riverside <br />Division, Department, or Region (if applicable) Q5 2,011 Q�I F only <br />Development Dept. , <br />Street Address <br />3900 Main St., Riverside, CA 92522 <br />Area Code /Phone Number E -mail <br />E] Amendment (Must explain in Part 5.) <br />951 -826 -5769 phogan @ riversideca.gov <br />Agency Contact (name and title) Date of Original Filing: <br />( month, day, year) <br />Pamela Hogan <br />2. Event For Which Tickets Were Distributed <br />Date(s) of Event: 12 1 17 1 10 Description of Event: Bret Mi chaels C oncert <br />Pace Value of Ticket: $ 83.00 <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: 0 Gratuitously ❑ Pursuant to Contract <br />3. Agency Official(s) Receiving Tickets) (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 I Describe the Public Purpose for the Distribution <br />Hinkley, Tricia <br />1 1 Promotion of the City Profile <br />4. Individual or Organization Receiving Ticket(s) (Provided at the behest of an agency official.) <br />Name of Behesting Agency Official: Tricia Hinkley <br />Name of Individual or Organization: Reenders, Kelly <br />Description of Organization: County o f San B <br />Address of Organization: 385 N. Arrowhead A San Bernardino, C 9 2415 <br />Number and Street City <br />Number of Tickets: 1 <br />Purpose for Distribution: (Describe the public purpose for the distribution to the organization.) <br />Promotion of the City Profile <br />State Zip Code <br />5. Verification <br />I h determined that the distribution of tickets set forth above is in accordance with the provisions of FPPC Regulation 18944.1. <br />Deanna Lorson Director 12/17/10 <br />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 />FPPC Form 802 (Feb/09) <br />FPPC Toll -Free Helplino: 866/ASK-FPPC (8661275 -3772) <br />