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CITY OF RIVERSIDE <br />Tax ID# 95-600-0769 <br />DONATION ACCEPTANCE FORM <br />Name of Donor: Cowboy Burgers & BBQ <br />Address: 5573 Arlington Ave. City: Riverside State: CA Zip: 92504 <br />Description of donation: Donation for Parent Navel Orange Tree Maintenance <br />Donor estimate of current value: $50.00 <br />Potential immediate or initial acquisition or installation cost, any on-going maintenance or <br />replacement cost: NA <br />Intended use: Offset costs of maintenance of the Parent Navel Orange Tree <br />Conditions of acceptance or donor designation: <br />Orange Tree <br />Funds go toward Parent Navel <br />Remarks: No Goods or Services were provided by the City in exchange for the donation <br />City Department and City Representative receiving donation: Parks, Recreation and Community <br />Services <br />Deposit Account Code: 5215000-374222 and Increase budget 5215000-421205 <br />APPROVED / DISAPPROVED <br />.3/2orz9 <br />Date <br />/DIpartment Head/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 />