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Agency Report of: <br /> Ceremonial Role Events and Ticket/Pass Distributions A Public Document <br /> 1. Agency Name on <br /> K, Uti-vtMu <br /> City of Riverside <br /> i <br /> Division, Department,or Region(If Applicable) DEC 2 4 2012 For Official Use Only <br /> Development Department City of Riverside <br /> Designated Agency Contact(Name,Title) ity Clerks Office <br /> Margie Haupt Arts and Cultural Affairs Manager <br /> El Amendment (Must provide explanation in Part 3.) <br /> Area Code/Phone Number E-mail <br /> 951 826-5649 mhaupt @riversideca.gov Date of Original Filing: 12/20/2012 <br /> (Month,Day,Year) <br /> 2. Function or Event Information <br /> Does the agency have a ticket policy? Face Value of Each Ticket/Pass$ 13.00 <br /> 9 Y p Y� Yes Q No❑ <br /> Event Description Festival of Lights-Ice Skating Tickets Date(s) 11 1 23 / 12 11 / 30 / 12 <br /> Provide Title/Explanation <br /> Ticket(s)/Pass(es) provided by agency? Yes® No❑ If no: <br /> Name of Source <br /> Was ticket distribution made at the behest Nog Yes❑ If yes: <br /> of agency official? Official's Name(Last,First) <br /> 3. Recipients <br /> *use Section A to identify the agency's department or unit. *Use Section S to identify an individual. -Use Section c to identify an outside organization. <br /> N <br /> A. Name of Agency,Department,or Unit ieket(s)/ Describe the public purpose made�pursUa6t tc the agency's policy <br /> P.ass(es) <br /> Riverside Metropolitan Museum 2 First Sunday Activities <br /> Riverside Public Library 2 First Sunday Activities <br /> Name of Individual Numberof <br /> B. (Cast First) 7icicet(s)/ Identify one ofthe fbllowing: <br /> P,ass(es) <br /> Ceremonial Role ❑ Other ❑ Income ❑ <br /> If checking"Ceremonial Role"or"Other'describe below: <br /> Ceremonial Role ❑ Other ❑ Income ❑ <br /> If checking"Ceremonial Role"or"Other'describe below: <br /> �+ <br /> Name of Outside Organization Numbetof <br /> C. Ticket(s)/ Describe the public purpose made'puCSUant to the sgei►cy's policy <br /> (include address and description) Passes) <br /> Mission Inn Museum 2 First Sundays Activities <br /> Riverside Art Museum 2 First Sundays Activities <br /> 4. Verification <br /> /have read and understand FPP Regulations 18944.1 and 18942.l have verified that the distribution set forth above,is in accordance with the requirements. <br /> ArW <br /> Sig4ure 0fgencdqea6 or esignee Prid Name V Title <br /> (Month,Dåy,Year) <br /> Comment: <br /> FPPC Form 802(4/12) <br /> FPPC Toll-Free Helpline:866/ASK-FPPC(866/275-7772) <br />