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CITY OF RIVERSIDE <br />Tax ID# 95-600-0769 <br />DONATION ACCEPTANCE FORM <br />Name of Donor: v IDS A ?-? <br />Address: 31S1-) -2_ City: 12"-'`L''rs ucj-Q-State: C `'t d --7b <br />Description of donation: (e,b • do <br />Donor estimate of current value: ' G'D • <br />Potential immediate or initial acquisition or installation cost, any on-going maintenance or <br />replacement cost: <br />Intended use: �"� s Co � 'nn 1-.S i csrS <br />v 2 2� <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: CA -I -n �"S o (' t c—e <br />Deposit Account Code: 14P.0of)t7D 5 3-`-1 a <br />APPROVED / DISAPPROVED <br />D41(D0)-(1 <br />ate Department ead /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 />