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Name of Donor: <br />Address: AV <br />CITY OF RIVERSIDE <br />Tax ID# 95-600-0769 <br />DONATION ACCEPTANCE FORM <br />-� 0 j <br />,'A -P.0 /',171 <br />(-City: 9 VVS1 AC State: Zip: (?--2 -S70 <br />Description of donation: C 0 Yes v , 6 CC) .Q 'C <br />Donor estimate of current value: t' 10 <br />Potential immediate or initialacquisitionor installation cost, any on-going maintenance or <br />replacement cost: A) f d� <br />Intended use: Vof- t✓, �Ye- "&' P v wee � <br />Conditions of acceptance or donor designation: kv.j < <br />Remarks: No Goods or Services were provided by the City in exchange for the donation <br />City Department and City Representative receiving donation: 6A Plet 5 Le -17 6oi <br />Deposit Account Code: <br />APPROVED/DISAPPROVED <br />4--7-2020 <br />Date <br />Date <br />S' -i 00cyff S- 3 7 L0_ �U o 0 <br />Department Head Elected Official Signature <br />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 />