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HomeMy WebLinkAboutForm 802 030911 Main St-Galaxy Theatre Giltter ReceptionAgency Report of Ceremonial Role Events and Ticket/Admission Distributions 1 Agency Name City of Atascadero Division, Department, or Region (if applicable) ress 6907 EI Camino Real Designated Agency Contact (Name, Title) Marcia McClure Torgerson City Clerk Area Code/Phone Number I E-mail 805-470-3400 1 mtorgerson@atascadero or 2. Function, Event, or Ceremonial Role Information Title Atascadero Main Street Glitter Fh Description SLOIFF Reception @ Galaxy Pq I of 2 - RECEIVEOPublic Document Date Stamp. e ' APR - 1 2011 For Official Use Only ITY OF ATASCADE40 CITY (`I F nw S C)Fl7l(-lr ❑ Amendment (Must provide explanation in Part 3.) Date of Original Filing 3/31/2011 (month, day, year) Face Value of Each Admission $ $25 00 Date(s) I I20� - 2016 Ticket(s)/Admission(s) provided by agency? Yes 0 No ❑ If no Name of Source Was the distribution to persons identified below made at the behest of an agency official? Yes El No ❑ If yes McKinney Wade, City Manager Official's Name (Last, First) and Title The identity of recipient(s) and the explanation Name * Check the income box if the agency official claims admission as (Last, first) Number of Agency taxable income. If the agency official performed a ceremonial role, or Admission(s)/ Official also provide a description. Organization Ticket(s) • If not income, describe the public purpose, including (Name, Address, Description) ceremonial roles, performed by an agency official, individual, or organization. Yes El Income Clay Jerry1 No ❑ attendance @ Main St. SLOIFF Glitter Receptio [3 Yes E] Income Fonzi Roberta 1 No ❑ attendance @ Main St. SLOIFF Glitter Receptio ❑ Yes p Income Sturtevant, Brian 1 No ❑ attendance @ Main St. SLOIFF Glitter Receptio O'Malley Tom 1 Nos ❑ attendance @ Main St. SLOIFF Glitter Receptio Income Bob Kelley 1 Nos � attendance @ Main St. SLOIFF Glitter Receptio 3 Verification 1 have read and understand FPPC Regulations 18944 1 and 18942. I have verified that the distribution of admissions, set forth above, is in accordance with the provisions. gWL� - "W" ft Wade McKinney City Manager 3/31/2011 — signature of Agency Head or Design k Print Name Title (month, day, year) Comment: (Use this space or an attachment for any additional information including amendment explanation.) FPPC Form 802 (2111) FPPC Toll -Free Helpline: 866/ASK-FPPC (8661275-3772) Agency Report of - Ceremonial Role Events and Ticket/Admission Distributions Pq z o�- 2— A A Public Document 1 Agency Name Date Stamp • . ' City of Atascadero 1 No ❑ For Oficial Use Only Division, Department, or Region (if applicable) Street Address 6907 EI Camino Real 1 No ❑ Designated Agency Contact (Name, Title) ❑ Amendment (Must provide explanation in Part 3.) Marcia McClure Torgerson City Clerk 3/31/2011 Date of Original Filing (month, day, year) Area Code/Phone Number E-mail 805-470-3400 mtorgerson@atasadero org Yes ❑ 2 Function, Event, or Ceremonial Role Intormatlon Title Atas Main Street Glitter Receptip Face Value of Each Admission $ 2- - 3 9 20'd 3 9 1 Description Date(s) Ticket(s)/Admission(s) provided by agency? Yes El No ❑ If no Name of Source Was the distribution to persons identified below made at the behest of an agency official? Yes 0 No ❑ If yes McKinney Wade City Manager Official's Name (Last, First) and Title The identity of recipient(s) and the explanation Number of n as 0 role, or Income Main St Glitter Party @ Galaxy opF ❑ Income Main St Glitter Party @ Galaxy opfo ElIncome Main St Glitter Party @ Galaxy o6 11© Income Income 3 Verification l have read and understand FPPC Regulations 18944 1 and 18942, t have verified that the distribution of admissions, set forth above, is in accordance with the provisions. Wade G McKinney City Manager 03/31/2011 4-- Signature of Agency Head or Design Print Name Title (month, day, year) Comment: (Use this space or an attachment for any additional information including amendment explanation.) FPPC Form 802 (2/11) FPPC Toll -Free Helpline 866/ASK-FPPC (8661275-3772) Yes Torgerson, Marcia 1 No ❑ Yes Lewis, Jim 1 No ❑ Yes McKinney Wade No ❑ Yes ❑ No ❑ Yes ❑ No ❑ n as 0 role, or Income Main St Glitter Party @ Galaxy opF ❑ Income Main St Glitter Party @ Galaxy opfo ElIncome Main St Glitter Party @ Galaxy o6 11© Income Income 3 Verification l have read and understand FPPC Regulations 18944 1 and 18942, t have verified that the distribution of admissions, set forth above, is in accordance with the provisions. Wade G McKinney City Manager 03/31/2011 4-- Signature of Agency Head or Design Print Name Title (month, day, year) Comment: (Use this space or an attachment for any additional information including amendment explanation.) FPPC Form 802 (2/11) FPPC Toll -Free Helpline 866/ASK-FPPC (8661275-3772)