2019-03-30 NASF 49th Scholarship Fund BallAg'ency Report of:
Ceremonial Role Events and Ticket/Pass Distributions A Public Document
1. Agency Name
City of Palm Spri ngs
: L Date Stamp California 802
Form
Di vision , Department, or Region (if applicable) For Official Use Only
Designated Agency Contact (Name, Title)
Shari Wrona , Executive Services Adminis trator D Amend ment (Must Provide Explanabon in Part 3 .)
Area Code/Phone Number
760-322-8632
E-mail
sha ri .wrona@palmspri ngsca .gov Date of O r iginal Filing : ______ _
(month, day, year)
2. Function or Event Information
Does the agency ha ve a ticket pol ic y? Yes {8l No •
Event Description : NASF 49th Scholarsh ip Fund Ball
Provide Title/ Explanation
Face Value of Each Ticke UPass $ _5_5_.o_o _____ _
Date( s) ~ ~ ~ __j__J __
Ti cket(s)/Pass(es ) provided by agency? Yes rgJ No D If no: _________________ _
Name of Source
Was ticket d istribution made at t he behest Yes • No~ If yes:------------------
Officiars Name (Last, First)
of agency official?
3. Recipients
• Use Section A to idc nlify the agen cy's department or unit. • Use Section B to identify an individual. • Use Section C t o ide ntify an o u tside organizati o n .
Number
A. Name of Agency, Department or Uni t of Ticket(s)I Descri be the public purpose made pursuant t o t he agency's policy
Pa sses
Number B. Name of Indivi dual of Ticket(s)/ Identify one of the following:
(Last, First) Passes
I
Moo n , Robert Ceremonial Role D Other ~ Income D
1 If checlang "Ceremonial Role" or ·other' descnbe below
Public Purpose as defined by PS Resolution No. 22454,
Secti on 1 (d)(vii )(viii)(xi)
Ce remonial Role D Other D Income D
If checking ·c eremon,a/ Role · or ·o ther' de sen be below
N ame of Outside Organization Number
C. of Tlcket(s)/ Describe the public purpose made pursuant to the agency's policy
(Include address and description) Pass es
4 . Ve rificati on
C Regulations 18944 .1 and 18942. I have verified that the distribution set forth above, is in accordance
with the requirements.
David Ready
Print Name
City Manager
Titl e (mon th, day, year)
FPPC Form 802 (2/2016)
FPPC Toll-Free Helplin e: 866/ASK-FPPC (866/275-3772)
•
Agency Report of:
Ceremonial Role Events and Ticket/Pass Distributions
Continuation Sheet
California 802
Form
A Public Document
Agency Name
City of Palm Springs
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, Departme·nt or Unit of Ticket(s)/
I Passes
--6. Number
Name of Individual ofTlcket(s)/
I (Last, First) Passes
I Name of Outside Orgailization NUmber
C. of Ticket(s)/
I (include address and description) Passes
Describe the public purpose niade pursuant. to the agency's policy
--~
Identify one of the following: I
Ceremonial Role D Other D Income D
If checking •ceremonial Role" or"Other" describe below:
Ceremonial Role D Other D Income D
If checking ·ceremonial Role"or "Other" describe below:
Ceremonial Role D Other D Income D
If checking ·ceremonial Role" or "Other" describe below:
Ceremonial Role D Other D Income D
If checking ·ceremonial Role" or"Other" describe be/ow:
Describe the public purpose made pursuant to the agency's policy I
'
FPPC Form 802 (2/2016)
FPPC Toll-Free Helpline: 866/ASK-FPPC (866/275-3772)
I