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CITY OF RIVERSIDE <br />Tax ID# 95-600-0769 <br />DONATION ACCEPTANCE FORM <br /> <br />Name of Donor: Noriko Shinozaki <br /> <br />Address: 11300 Magnolia Apt 11 City: Riverside State: CA Zip: 92505 <br /> <br />Description of donation 30 handmade masks <br /> <br />Donor estimate of current value: $90.00 <br />Potential immediate or initial acquisition or installation cost, any on-going maintenance or <br />replacement cost: n/a <br /> <br />Intended use: For use by Homeless Solutions <br /> <br />Conditions of acceptance or donor designation: None <br /> <br />Remarks: No Goods or Services were provided by the City in exchange for the donation <br /> <br />City Department and City Representative receiving donation: Fire EOC Mark Annas <br />Deposit Account Code: 9915400885-37422200 <br /> <br />APPROVED / DISAPPROVED <br /> <br /> <br />Date Department Head/Elected Official Signature <br /> <br /> <br />Date Chief Financial Officer Signature (if needed) <br /> <br /> <br />Date Submitted to Council Date Approved by Council (if needed) <br /> <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