ITY OF CHU' LA VISTA
DONATION ACCEPTANCE FORM
Name of donor:
Address:- b( QJi Stater_ ZIP! (7 Q 121
I of
I
Description. of donation: t, S V)OAM 14'
Donor estimate of current value: 1I.
r_
Co00
Potential. immediateor initial. acquisitionor installationcost, anyon-goingmaintenanceor replacement cost:
Intended use: L
Conditions. of acceptance or donor designation:
Remarks:
Citydepartmentreceivingdonation: C
APPROVED] DISAPPROVED
I-ll oa
Date
Date
Date Submitted to Council
Date
Department Head' s Signature
City Manager's Signature
DateApprovedby Council
Mayor' s Signature
Note; TheCityofCh.41aVistacannotguaranteefittarefiinding:for:repair, muintenance,;useorreplcemenrof:d§nated;items..
CC: CityCouncil, FinanceD.epartinetCityManager's
OfficePage 1 of. 2