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CITY OF RIVERSIDE RECEVED <br /> Tax ID#95-600-0769 NOV 2 2 2017 <br /> DONATION ACCEPTANCE FORM <br /> City of Riverside <br /> City Clerk's Office <br /> Name of Donor: ` /l/6 / 1////4 <br /> Address: 7Y 9 a//1--1-416-77 City: S&l '6 State: c444 Zip: 9,PO3e" <br /> Description of donation: C/f�c: 11 I <_>2-0) 9-z--6 <br /> Donor estimate of current value: /1///' <br /> Potential immediate or initial acquisition or installation cost, any on-going maintenance or <br /> replacement cost: <br /> Intended use: 2- c%• <br /> Conditions of acceptance or donor designation: ^v/,9 <br /> Remarks: No Goods or Services were provided by the City in exchange for the donation <br /> City Department and City Representative receiving donation: S67 v4/6-4/ <br /> Deposit Account Code: 7,11t7; <br /> 7,2 O za5./ Lp <br /> APPROVED/ DISAPPROVED <br /> Date Department Head/Elected 0 cial 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 />