Donation Acceptance Forms
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5/18/2020 10:15:37 AM
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CITY OF RIVERSIDE <br />Tax ID# 95-600-0769 <br />DONATION ACCEPTANCE FORM <br />Name of Donor: Christi Case <br />MAY 18 2020 <br />Cit' of Riverside <br />City Clerk's Office <br />Address: 7121 Westport Street City: Riverside State: CA Zip: 92506 <br />Description of donation: Visa Gift Card <br />Donor estimate of current value: _ _ $150.00 <br />Potential immediate or initial acquisition or installation cost, any on-going maintenance or <br />replacement cost: Not applicable <br />Intended use: Donation for the City of Riverside Firefighters Association (office supplies, <br />postage, and miscellaneous items used for day-to-day operations). <br />Conditions of acceptance or donor designation: No conditions. <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 Department/ Captain Matthew <br />Mathis <br />Deposit Account Code: Not applicable <br />APPROVED / DISAPPROVED <br />Date Department Head/Elected 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 />
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