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RECH=r� <br />CITY OF RIVERSIDE JUN a7 2019 <br />Tax ID# 95-600-0769 <br />DONATION ACCEPTANCE FORM City of Riverside <br />/ DD __ -�II 1 City Clerk's Office <br />Name of Donor: y�Ri d er5/ dem Ro+cir� rati-(1d0.+101 ) <br />Address: P.D.fILi Y %3„2 City: /Zrbeo-Trr/ro State: (1.11. Zip: 9a2S_ <br />1I0 <br />Description of donation: Fnr /%!AnelOff e_ dr File Far Life- C0.rA5 <br />and . r• - •fddit, <br />Donor estimate of current value: 1/f fier9 <br />Potential immediate or initial acquisition or installation cost, any on-going maintenance or <br />replacement cost: ISA_ <br />Intended useuil"Nikn 5P drc F -bp_ For Lift earn <br />p 1.tau <br />Conditions of acceptance or donor designation: Ilk L., -Ru rid MUj kir.- as er <br />+(2 parPkamfp_ Frle -far ri.ifr, supe <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. i4r t e/ 1 eF19121"e--- <br />Deposit Account Code: 35-0000 '37 2/a' .l <br />APPROVED / DISAPPROVED <br />Date <br />drc <br />Departmertiead5 edted Official Signature <br />Date Chief Financial Officer Signature Of 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 />