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CITY OF RIVERSIDE <br />Tax ID# 95-600-0769 <br />DONATION ACCEPTANCE FORM <br />Name of Donor: Knights of Columbus (Ruben Rosas) <br />Address: 10622 Bellegrave Ave. City: Mira Loma State: CA Zip: 91752 <br />Description of donation: Monetary donation for The Friendly Stars program. <br />Donor estimate of current value: $2,091.20 <br />Potential immediate or initial acquisition or installation cost, any on-going maintenance or <br />replacement cost: For The Friendly Stars Programming. <br />Intended use: Intended to be used to increase programing for friendly stars participants. <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: Hilda Hernandez <br />Deposit Account Code: 5205001-426500 <br />APPROVED / DISAPPROVED <br />.: rl <br />De4hardm 17feadlEl f -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 />