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CITY OF RIVERSIDE <br />Tax ID# 95-600-0769 <br />DONATION ACCEPTANCE FORM <br />Name of Donor: la"g"s tci-e c <br />Address: _ City: State: Zip: <br />Description of donation: C� • CO <br />Donor estimate of current value: 1(. CAD <br />Potential immediate or initial acquisition or installation cost, any on-going maintenance or <br />replacement cost: <br />Intended use: '-dv a -'-i �c �-c s G�w�rY1 y ti�� 44e..c.p_p- csv; <br />IL-ot '' 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: G' C1-42-4, te-2S Le <br />Deposit Account Code: 1 c9- d Dc'0 O --� �- 0 <br />APPROVED / DISAPPROVED <br />Date <br />ov -1013.4 <br />1)C)7.' <br />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 />