Donation Acceptance Forms
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5/18/2020 10:15:46 AM
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CITY OF RIVERSIDE HKIEWED <br />Tax ID# 95-600-0769 MAY 18 2020 <br />DONATION ACCEPTANCE FORM <br />City <br />p've w <br />city CIS E �� � <br />Name of Donor: t� i-l�nr� <br />Address: 6� L..EAm t A PTjt-krLCity: + jUzs o State: CA Zip: 9222 <br />Description of donation: 100 CLc,i7-1 FA=Q- <br />Donor estimate of current value: <br />Potential immediate or initial acquisition or installation cost, any on-going maintenance or <br />replacement cost: <br />Intended use: �� Fc txs T `2 % Nz iM-s <br />Conditions of acceptance or donor designation: N6 - <br />Remarks: No Goods or Services were provided by the City in exchange for the donation <br />City Department and City Representative receiving donation: K►�Zrain ��.-+��; / t� i��� ilz <br />Deposit Account Code: <br />APPROVED / DISAPPROVED <br />Date <br />Date <br />Date Submitted to Council <br />Department Head/Elected Official Signature <br />Chief Financial Officer Signature (if needed) <br />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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