ATTACHMENT A
CITY OF PASADENA MANUAL OF PERSONNEL & ADMINISTRATIVE RULES SEOION 10 j FINANCIAL POLICIES
CITY OF PASADENA
DONATION / GIFT ACCEPTANCE FORM
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Name of Donor: i^^yYr-^^ VOL.\C^ irOt^^DM"tC^^
Addresser? 5. LA^Av^Wcitv: r-?^V^^^ State: Zip: 6^A-^U(9? Description of donation:"'1 P-AC-I^- y: T^-^< I t/^-l6i ^4Vr-J t. t\B Donor estimate of current value: ^>'2C5~ !'Y"'t.'). 00
Potential immediate or initial acquisition or installation cost, an on-going maintenance or replacement cost; ^'SOC^, ^(-)
Intended use;%-fWU Oto^-AT\O.K/I1Tll4=9T-. TC^ •i l^C^Nf^ TA^l<=3 S\.\6A\- ^> ^^-'<JWuST^T~0?TBHC(Jif2^, t^l^^^i l'i-;^-Psc^4S Conditions of acceptance or donor desienation: N/^. _At4p ^7t^N^ ^C^4.i /
Remarks:_t^&.
City Department receiving donation/eift: °H-)^! C-^ UUFA-t^TT^-^^^' APPROVED/ DISAPPROVED (Please circle)
Date . / -]
iHy[ i
Date
De|3a.rtment Head Signatun
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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