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CITY OF RIVERSIDE <br />Tax ID# 95-600-0769 <br />DONATION ACCEPTANCE FORM <br />Name of Donor: T' b'. \vt_CLYs -ct-"' 1-Q -t=r)u 4,, <br />Address: �'U 9 City: �v..4.-1(sLck State: 01' Zip:c2l <br />Description of donation: T'w ±C -12.--}-s EV --kwO V 1P 1e-ce.-gyp* ' G -S- <br />Donor estimate of current value: A .1)p v oX • 99--S-- • Civ <br />Potential immediate or initial acquisition or installation cost, any on-going maintenance or <br />replacement cost: <br />Intended use: DC) moa►-ms42e-Pit.c.4--N <br />R -o+ �•E�-1 e- <br />—Pr <br />Conditions of acceptance or donor designation: <br />Remarks: No Goods or Services were provided by the City in exchange for the donation <br />City Department and City Representative receiving donation: � Civ L) s d _____ C42_ <br />Deposit Account Code: a 00000 as D_- <br />APPROVED/DISAPPROVED <br />I )-0 -24 <br />Date Department He d/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 />