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Tickets Provided by <br />Agency Report <br />1. Agency Name <br />City of Riverside <br />A Public Document <br />Date Stamp <br />TICKETS PROVIDED BY <br />AGENCY REPORT <br />ulvlslon, Dep artment , or Region if applicable) For official Use Only <br />Development Department <br />Street Address i,- 7 2C I0 �. <br />I f <br />3900 Main Street, Riverside, CA 92522 <br />Area Code /Phone Number rnmhaupt@riversideca.gov -mail <br />r ❑ Amendmel t (A USt explain in Part 5.) <br />951 - 826 -5649 <br />Agency Contact (name and title) bate of Original Filing: 1 2/28 / 10 <br />(month, day, year) <br />Margie Haupt, Interim Arts and Cultural Affairs Manager <br />2. Event For Which Tickets Were Distributed <br />Date(s) of Event: 11 28 1 10 Description of Event: Festiva of Lig - Ice Skating Tickets <br />12 1 28 1 10 Face Value of Ticket: $ 1 3.00 <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: ❑ Gratuitously ❑ Pursuant to Contract <br />3. Agency Officials) 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 I Describe the Public Purpose for the Distribution <br />See Attached List <br />142 i 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 />I have determined that the distribution of tickets set forth above is in accordance with the provisions of FPPC Regulation 18944.1. <br />/�i� Tina English Asst. Development Director 12/28110 <br />Signature ofAgenc e or esignee Print Name Titie <br />(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 (FebiO9) <br />FPPC Toll -Free Helpline: 866/ASK-FPPC (8661275 -3772) <br />