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CITY OF RIVERSIDE <br />Tax ID# 95-600-0769 <br />DONATION ACCEPTANCE FORM <br />Name of Donor: —ravv 1 e RG�Y j <br />Address: 31.06. 3 'tcriv- sI--. City: -rs L.,4442_,State: efi" Zip: °la"S D I <br />Description of donation: Le. 1 U vi c1eU_S <br />Donor estimate of current value: 14 30 • W <br />Potential immediate or initial acquisition or installation cost, any on-going maintenance or <br />replacement cost: <br />Intended use: P-0 ;-H 'oG1►-oi S cob—, 42—e- G�P•f't art <br />P <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: G CA -p v k's C:44-11 <br />r-' <br />Deposit Account Code: l a'bc c c •-l5� 3a-� - 3r1 �-1 �--a <br />APPROVED / DISAPPROVED <br />Date <br />L..1(+0 2A4 <br />1 <br />Department 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 />