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Name of Donor: <br />CITY OF RIVERSIDE <br />Tax ID# 95-600-0769 <br />DONATION ACCEPTANCE FORM <br />- ✓c-•� cf -e_ [ tee > o - •S <br />� a Gig � cc` Ste �4 <br />1.1 <br />Address: 3to`'�� 7€ . City: WUPX-&;State:C4 <br />Zip: cySb--) <br />Description of donation: r. r, b �+�S a 4 S7 (10 CcupcYv1 , S c k�-•moi <br />a— b h t y +-S ) <br />Donor estimate of current value: 41 .z) [� <br />Potential immediate or initial acquisition or installation cost, any on-going maintenance or <br />replacement cost: <br />Intended use: -v 0 c va s Cc v'r »-1) S <br />l -ev Z� <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: C-):1---3 Cl -2-v <br />Deposit Account Code: l > CD o — L-ra) 3 a rl 3 H <br />APPROVED / DISAPPROVED <br />61)2-L( <br />Date <br />Department end/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 />