Attachment A
CITY OF PASADENA MANUAL OF PERSONNEL & ADMINISTRATIVE RULES SECTION 10 | FINANCIAL POLICIES
CITY OF PASADENA
DONATION / GIFT ACCEPTANCE FORM
Name of Donor:'f DononC/ji^rni^ [Af^W P/fc(Tbl /JtX^LT^?- Address:^ ^ -^JC^m^A. ?\d- Citv/%$4^n^^ State: ZipCjL- ^/l^^ Description of donation: 202^) ^J^YrZ^tT^O^ &»^ I'PpLl^ U/)^M y^f^ 6^^t^^^y^^ ^tijpyvW-'Donor estimate of current value: ^l^f^D WQ [l/^/d^^lJ /5lrf-(-77^^ ^^ Potential immediate or initial acquisition or installation cost,/^n on-going maintenance or replacement cost:/In ^tYut^C ^TOOO^O/ (\^rJ^scA ^A^.
Intended useL^. ll^^tjj UL^^ 0'F^/1^ \t^\^JL ^llt |^ t^ KH^O ^+rxvi?p?pi- (k ^\XUL l<L3,~'^r^P|cyrY^/a*fe'
Conditions of acceptance or donor designation: I KU<L \f€Y\,[C\jl_~ ^li^NAj u^pA ^ 2i^D mi^-
RemarKs:4^ \^V\\C>[l l/^lLl ^AjQ. f\ C^fC^ l^f .
^hi6L^tH^l'h43 (^^/L i^> s^yvi^ li^^.
City Department receiving donation/eift:- .5AA^I^A 'PpU^ T^UM-hr^^ APPROVED/ DISAPPROVED (Please circle)
Date
^
Date
/^/?^
Department Head SigTia^ure
City Manager Signature
DateApproved by City Council
DateMayor Signature
Note: The City of Pasadena cannot guarantee future funding for repair, maintenance, us or replacement of donated items.
CC: City Council, Finance Department, City Clerk
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