Laserfiche WebLink
CITY OF RIVERSIDE <br />Tax ID# 95-600-0769 <br />DONATION ACCEPTANCE FORM <br />Name of Donor: --TQ 1-)5-p_U''+rTh <br />Address: 3LI M est t city: C2►v-Q-YSki _State: C-' Zip: .71 -S b) <br />Description of donation: - -Q <br />AL <br />A n h <br />LAct v .Fv r c tcc�n *vim% c 1 ti. AV <br />Donor estimate of current value: 41a , CPO <br />Potential immediate or initial acquisition or installation cost, any on-going maintenance or <br />replacement cost: <br />Intended use: aD 9 j mot.+-ctS g (bw„r,^ tss tcr'�� h a <br />Pry <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: Gtize ICC Off- L <br />Deposit Account Code: .4- dC)aC 3a 1 fl 1 a <br />APPROVED / DISAPPROVED <br />DateICOLF <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 />