CITY OF FONTANA
COMMUNITY SERVICES DEPARTMENT
DONATION ACCEPTANCE
(For All Donations)
Name of Donor/Organization:
Adam Perez
Address:
3649 Mission Ine Ave. Fl 2nd
Riverside CA 92501
Contact Person, Title: Phone No.
Adam Perez
Type of Donation: (Check boxes)
Monetary Amount s Receipt No.
$1,000.00 1050605.002
(Attach Copy of Receipt)
Goods/Services Estimated Value $ Description
Intended use of Donation:
X Specific → Description:
2025 Veterans Day Celebration
General
Thank you/acknowledgement letter sent to Donor? (Required for ALL donations) Attach copy of acknowledgement letter to this form.
G.E.T. Online Donation Tracking Form Has Been Completed. (Required for ALL donations with a value greater than $500.00) Received By: Date:
Diana Ambriz 10/10/2025
= - = FOR ADMINISTRATION USE ONLY - E F
City Council Agenda Date
10/22/2025
Entered in Novus by: Date
This form must be filled out for all donations received regardless of value amount. This donation must be approved by City Council prior to any spending or use of the donation. https://fontana365-my.sharepoint.com/personailefarrar_fontanaca_gov/Documents/Documents/EVENTS/VETERANS Day/Adam Perez_Donation Acceptance 2025.x/s\10/15/2025110:40 AM
City of Fontana Receipt #1050605.002
8353 Sierra Avenue
Fontana, CA 92335 Nov 26, 2024 10:42 AM
Phone: (909) 349-6900
FAX: (909) 349-6911
Email: [email protected]
ADAM PEREZ FOR ASSEMBLY 2024
ADAM PEREZ FOR ASSEMBLY 2024 FONTANA
3649 MISSION INN AVE FL 2ND Community
RIVERSIDE, CA 92501 Services
Prepared By: csanchez
Company ID: 207
Primary phone: (909) 999-9999, Secondary phone: --
Payment Summary
Check: $1,000.00 Check # 1100
Total Received: $1,000.00 Total Payments: $1,000.00
• Transactions
Customer Description Item Unit Qty Fee Charge
Adam Perez For Events General Revolving #0168.301.FA24 General Per 1.00 $1,000.00 $1,000.00 Assembly 2024 Action: Enroll Seat
3649 Mission Inn Ave FL
2nd Meets: From September 2, 2024 to December
Riverside, CA 92501 31, 2024
Primary phone: (909) 999- Location: Community Services Department office
Email: -
ID: 56787
Total Charges $1,000.00
Total Payments $1,000.00
Balance $0