803 (Amndt) Bank of America (Long Night of Arts)
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8/1/2013 2:26:05 PM
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Behested Payment Report A Public Docum Behested Payment Report <br /> 1. Elected Officer or CPUC Member(Last name,First name) I I L.Wt&.3illmy • • <br /> Øtq E)1 1,41 LL► Vs(Y) AUG 1 2013 <br /> Agency Name For official use only <br /> City of Riverside <br /> Agency Street Address City Clerk's OffIC <br /> Q o o cv,,-VI- S- Y"e f- ,t!-_o s Ø CA ��s� 1 zw <br /> Designated Contact Person(Name and title,if different) <br /> 0 Amendment(see Part 5) <br /> Area Code/Phone Number E-mail(optional) Date of Original Filing: IJ 2013 <br /> (9 5^l (month,d y,year) <br /> sz, -mss S 1 <br /> 2. Pjaayor Information (For additional payorrs,,include an attachment with the(n�ames(�and addresses.) �'' l <br /> �Ja c� Y ricer Ø�_z yc �- c�"3� /AMP r ��a l DC2 Y� id 'lj O'1 _ <br /> Name <br /> Address City State Zip Code <br /> 3. Payee Information (For additional payees,include an attachment with the names and addresses.) <br /> \ rSi � <br /> Na <br /> IV's <br /> Address City State Zip Code <br /> 4. Payment Information (Complete all information.) <br /> Date of Payment: 0 ) Amount of Payment: (In-Kind FMV) $ / d�Q d G <br /> (month,day,y ar (Round to whole dollars.) <br /> Payment Type: Q onetary Donation or ❑ In-Kind Goods or Services(Provide description below) <br /> Brief Description of In-Kind Payment: <br /> Purpose:(Check one and provide description below) ❑Legislative ❑Governmental (Charitable <br /> Describe the legislative, governmental, charitable purpose, or event: ScfY�6t <br /> l o h f�/i �j c? ?� [in1_c �✓t,o ✓ D�'l <br /> 5. Amendment Description or Comments <br /> ---- � 1 I <br /> k�. n c 1 c,-� 't Y\n 6 U Ø`k't(JV1 <br /> 19r'esz BYE. 1 U-egs 1 Q.Y- <br /> 6. Verification <br /> I certify, under penalty of perjury under the laws of the State o ontained <br /> herein is true and complete. <br /> Executed on 6 i I �) ' By <br /> DATE <br /> ecember/09) <br /> 61275-3772) <br />
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