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RECEIVED <br /> CITY OF RIVERSIDE <br /> Tax ID# 95-600-0769 MAR 2 3 2018 <br /> DONATION ACCEPTANCE FORM <br /> City of Riverside <br /> City Cle;k's Office <br /> Name of Donor: Kee\ Ugh 0 <br /> Address: 21 SS HaoKa rno rc- ?I City: RI rsN State: CA Zip: 92506 <br /> Description of donation: CK A \q'3G S 000 <br /> Donor estimate of current value: N/r. <br /> Potential immediate or initial acquisition or installation cost, any on-going maintenance or <br /> replacement cost: NIA <br /> Intended use: R:wr-sc\N w Kc\ - vrv/' <br /> Conditions of acceptance or donor designation: MSA <br /> Remarks: No Goods or Services were provided by the City in exchange for the donation <br /> City Department and City Representative receiving donation: SGT- M;\\;.1 <br /> Deposit Account Code: 0000-1'2-0 - -'7-5\y0 <br /> APPROVED/ DISAPPROVED <br /> 3 <br /> Date Department Head/Elec ed 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 />