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RECEIVED <br /> CITY OF RIVERSIDE DEC 0 4 2017 <br /> Tax ID# 95-600-0769 <br /> DONATION ACCEPTANCE FORM City of Riverside <br /> City Clerk's Office <br /> Name of Donor: Firefighters Charitable Foundation, Inc. <br /> Address: One West Street City: Farmingdale State: <br /> NY Zip: 11735 <br /> Description of donation: Check#020731 in the amount of$300.00 <br /> Donor estimate of current value: $300.00 <br /> Potential immediate or initial acquisition or installation cost, any on-going maintenance or <br /> replacement cost: N/A <br /> Intended use: Fire Department Needs <br /> Conditions of acceptance or donor designation: No conditions. <br /> Remarks: No Goods or Services were provided by the City in exchange for the donation <br /> City Department and City Representative receiving donation: Fire/Michael Staley <br /> Deposit Account Code: 3510000-374222 <br /> APPROVED / DISAPPROVED <br /> 7-3O <br /> Date Department Head lected Official Signature <br /> Date Chief Financial Officer Signature (if needed) <br /> Date Submitted to Council Date Approved by Council (if needed) <br /> Note: The City of Riverside cannot guarantee future funding for repair, maintenance, use or replacement <br /> of donated items. <br /> Original to City Clerk <br /> cc: City Council, Finance Department, Receiving Department <br />