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CITY OF RIVERSIDE RECEIVED <br /> Tax ID# 95-600-0769 FEB 14 2018 <br /> DONATION ACCEPTANCE FORM <br /> City of Riverside <br /> �- <br /> C4 Clerk's Office <br /> Name of Donor: L DL VE <br /> Address: A9 . 2iT)( SVS City: C77).(-1 State: 4 Zip: 9z3Z $' <br /> ''ff r�, <br /> Description of donation: HFA/c' # ��.S- a��2 r.2 <br /> Donor estimate of current value: /l/41 <br /> Potential immediate or initial acquisition or installation cost, any on-going maintenance or <br /> replacement cost: /v/A <br /> Intended use: /L/ A4oe 6c C g - <br /> Conditions of acceptance or donor designation: /�/'�i4 <br /> Remarks: No Goods or Services were provided by the City in exchange for the donation <br /> City Department and City Representative receiving donation: <br /> Deposit Account Code: a900 o 02 S/ %D <br /> APPROVED / DISAPPROVED <br /> `16 4 .6 AD <br /> Date -'Department Head/Electe 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 />