HomeMy WebLinkAboutRuby Affair - Signed Form 802Agency Report of:
Ceremonial Role Events and Ticket/Pass Distributions
1. Agency Name
City of Dublin
Division, Department, or Region (if applicable)
E
(Name, Title)
Marsha Moore, City Clerk
(925) 833-6644 1 marsha.moore@dublin.ca.gov
Function or Event Information
Does the agency have a ticket policy? Yes ❑ No ® Face Value of Each Ticket/Pass $
Event Description: City's 40th Anniversary Gala Celebration Date(s) 08 / 06 t
Provide Title/Explanation
Ticket(s)/Pass(es) provided by agency? Yes E No ❑ If no:
Date Stamp
A Public Document
For Official Use Only
❑ Amendment (Must Provide Explanation in Part 3.)
Date of Original Filing:
(month, day, year)
100
Name of Source
Was ticket distribution made at the behest Yes ❑ No N If yes:
Official's Name (Last, First)
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
B. Name of Individual
Number
of Ticket(s)/
Identify one of the following:
(Last, First)
Passes
Ceremonial Role ® Other ❑ Income ❑
Hernandez, Melissa and one guest per FPPC 18942(13)
2
If checking 'Ceremonial Role"or"OthePdescribe below:
Will have a speaking role in program.
Ceremonial Role E Other ❑ Income ❑
Josey, Jean and one guest per FPPC 18942(13)
2
If checking 'Ceremonial Role" or 'Otherdescribe below:
Will have a speaking role in program.
Name of Outside Organization
C.
Number
of Ticket(s)/
Describe the public purpose made pursuant to the agency's policy,
(include address and description)
Passes
4. Verification
1 have read and understand FPPC Regulations 18944.1 and 18942. 1 have verified that the distribution set forth above, is in accordance
with the requirements.
Linda Smith City Manager— 4 Y_Z Zp2Z
Signature of Agency Head or Designee Print Name Title (moot , day, year)
Comment:
FPPC Form 802 (212016)
FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772)
Agency Report of: , California
02
Ceremonial Role Events and Ticket/Pass Distributions '
Continuation Sheet A Public Document
Agency Name
City of Dublin
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)/
Passes
Describe the public purpose made pursuant to the agency's policy
B. Name of Individual
(Last, First)
Number
of Ticket(s)/
Passes
Identify one of the following:
Kumagai, Shawn and one guest per FPPC 18942(13)
2
Ceremonial Role ® Other ❑ Income ❑
If checking 'Ceremonial Role' or "Other' describe below:
Will have a speaking role in the program.
Hu, Sherry and one guest per FPPC 18942(13)
2
Ceremonial Role ® Other ❑ Income ❑
If checking 'Ceremonial Role" or'Other" describe below:
Will have a speaking role in the program
Mccorriston, Michael and one guest per FPPC 18942(13)
2
Ceremonial Role N Other ❑ Income ❑
If checking 'Ceremonial Role" or °Other' describe below.
Will have a speaking role in the program.
Ceremonial Role ❑ Other ❑ Income ❑
If checking 'Ceremonial Role" or'Other' describe below:
Name of Outside Organization
C.
(include address and description)
Number
of Ticket(s)/
Passes
Describe the public purpose made pursuant to the agency's policy
'
FPPC Form 802 (2/2016)
FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772)