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Agency Report of: RECEIVED <br /> Ceremonial Role Events and Ticket/Pass Distributions JAN 1 7 2013 A Public Document <br /> 1. Agency Name Date Stamp <br /> City of Riverside ity of Riverside 7Only <br /> Division,Department,or Røgion(t/Applicable) {ty Clerk's CffIC For Officia <br /> Development Departmet <br /> Designated Agency Contact(Name,Title) <br /> Margie Haupt Arts and Cultural Affairs Manager <br /> ® Amendment (Must provide explanation in Part 3.j <br /> Area Code/Phone Number E-mail <br /> Filing:Original Date of Ori g 12/24/2012 <br /> 951 826-5649 mhaupt @riversideca.gov g <br /> (Month,Day,Year) <br /> 2. Function or Event Information <br /> Does the agency have a ticket policy? Yes® No❑ Face Value of Each Ticket/Pass$ 13.00 <br /> Event Description Festival of Lights-Ice-Skating Tickets Date(s) 11 t 23 / 12 11 / 30 t 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 No® 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 B to identify an individual. -Use Section C to identify an outside organization. <br /> Number of <br /> A Name of Agency,Department or Unit Ticket(sjl Describe the public purpose made pursuant to the agency's policy <br /> Pass(es) <br /> Riverside Metropolitan Museum 2 Rewarding academic achievements by Riverside students <br /> Riverside Public Library 2 Rewarding academic achievements by Riverside students <br /> Name of Individual Number of <br /> B. rr ref- Ticket(s)l identify one of the following: <br /> pass(es) <br /> Ceremonial Role ❑ Other ❑ Income ❑ <br /> If checking Geremonial Role"or"Other"describe below: <br /> Ceremonial Role ❑ Other ❑ Income ❑ <br /> If checking'Ceremonial Role"or"Other"desonbe below. <br /> Name of Outside Organization Number of <br /> C. Ticket(s)t Describe the public purpose made pursuant to the agency's policy <br /> (include address and description) Pass(es) <br /> Mission Inn Museum 2 Rewarding academic achievements by Riverside students <br /> 3696 Main St.Riverside CA 92501 <br /> Riverside Art Museum 3425 Mission Inn 2 Rewarding academic achievements by Riverside students <br /> Ave. Riverside CA 92501 <br /> 4. Verification <br /> i have read and understand FWegulations 18944.i and 18942.t have verified that fhe distribution set forth above,is in accordance with fhe requirements. <br /> Signature gency ead or lesignee rint Name Title U _(Monti,Day,Year) <br /> Comment: <br /> FPPC Form 802(4/12) <br /> FPPC Toll-Free Helpline:866/ASK-FPPC(8661275-7772) <br />