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CITY OF RIVERSIDE <br />Tax ID# 95-600-0769 <br />DONATION ACCEPTANCE FORM <br />Name of Donor: <br />Address: 444 .,(� j1p.Y1 G6'es'f - City: 9A)e rside State: Zip: <br />Description of donation: Z iu LD <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: <br />Conditions of acceptance or donor designation: A10/ )p <br />r <br />Remarks: No Goods or Services were provided by the City in exchange for the donation <br />City Department and City Representative receiving donation: ,'�!zckie-F lead - <br />Deposit Account Code: <br />APPROVED IDISAPPROVED <br />/- /y -OV <br />Date <br />Date <br />Date Submitted to Council <br />1-3 <br />X�� ", <br />apartment 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 />