HomeMy Public PortalAbout11-09-21 - Cooper, MonicaAgency Report of:
Ceremonial Role Events and Ticket/Pass Distributions
1.Agency Name
City of Carson
Division,Department,or Region (if applicable)
Designated Agency Contact (Name,Title)
Area Code/Phone Number E-mail
2.Function or Event Information
Does the agency have a ticket policy?Yes No[]_Face Value of Each Ticket/Pass $
Event Description:Landon Dennevan Unvell and Soosor f Date(s)10703)21 / /
Provide Title/Explanation
Ticket(s)/Pass(es)provided by agency?Yes]No[]_!fno:
70.00
Name of Source
istributi If yes:Was ticket distribution made at the behest Yes]No y Sheets Nae Fad
of agency official?
3.Recipients
*Use Section A to identify the agency's department or unit.*Use Section B to identify an individual.Use Section C to identify an outside organization.
Number
A.Name of Agency,Department or Unit of Ticket(s)/Describe the public purpose made pursuant to the agency’s policy
Passes
Cae NumberB.Name of Individual of Ticket(s)/Identify one of the following:
(Last,First)Passes
Ceremonial Role Other C Income CL]
Cooper Monica 2 If checking “Ceremonial Role”or “Other"describe below:
Ceremonial Role C Other Cl Income C]
If checking “Ceremonial Role”or “Other”describe below:
H A NumberCc_Name of Outside Organization of Ticket(s)/Describe the public purpose made pursuant to the agency’s policy.(include address and description)Passes
derstand FPPC,Regulations 18944.1 and 18942.Jfiave veNfied that the distribution set forth above,is in accordance
Xo Mo priceZSigngpine’of Agaanyriead or Designee Print Name
Comment:
FPPC Form 802 (2/2016)
FPPC Toll-Free Helpline:866/ASK-FPPC (866/275-3772)
Agency Report of:
Ceremonial Role Events and Ticket/Pass Distributions
Continuation Sheet
Agency Name
City of Corson
3.Recipients
*Use Section A to identify the agency's department or unit.*Use Section B to identify an individual.Use Section C to identify an outside organization.
Number
A.Name of Agency,Department or Unit of Ticket(s)/Describe the public purpose made pursuant to the agency’s policy
Passes
se NumberB.Name of Individual of Ticket(s)/Identify one of the following:
(Last,First)Passes
Ceremonial Role Ey Other C Income C]
If checking “Ceremonial Role"or “Other”describe below:
Cooper,Monica 2 Landon Donnovan Unveil and Soccor match
Ceremonial Role C]Other CO Income Cj
if checking “Ceremonial Role"or “Other”describe below:
Ceremonial Role CO]Other CL Income CO
If checking “Ceremonial Role"or “Other”describe below:
Ceremonial Role O Other C Income C]
If checking “Ceremonial Role”or “Other”describe below:
:.NumberCc:_Name of Outside Organization of Ticket(s)/Describe the public purpose made pursuant to the agency’s policy(include address and description)Passes
FPPC Form 802 (2/2016)FPPC Toll-Free Helpline:866/ASK-FPPC (866/275-3772)