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HomeMy WebLinkAboutForm 802 030911 Atasc Main Street-Galaxy Theatre Glitter MovieAgency Report of - Ceremonial Role Events and Ticket/Admission Distributions 1 Agency Name City of Atascadero 6907 EI Camino Real Marcia McClure or Region (if , City Clerk 805-470-3400 1 mtorgerson@atasadero org 2 Function, Event, or Ceremonial Role Information Title Atas Main Street Glitter Receptip Description "The Patsy"/"Swingtime" screen F� 1 0 � Z- RECEIVEDA Public Document Date Stamp . e t APR - 1 2011 � For Official Use Only rY OF ATASCADERO ITY CLERK'S OFFICE ❑ Amendment (Must provide explanation in Part 3.) Date of Original Filing 3/31/2011 (month, day, year) Face Value of Each Admission $ 9 00 Date(s) 3 /�J 2016 - 3 — / 9 / 1 Ticket(s)/Admission(s) provided by agency? Yes I] 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 reciplent(s) and the explanation Name a Check the income box If the agency official claims admission as (fast, 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 or anization. Yes El income Sturtevant, Brian 1 No [3 Movie tied to Main St Glitter Party @ Galaxy o6 Yes El Income Fonzi, Roberta 1 No ❑ Movie tied to Main St Glitter Party @ Galaxy o 6 13 Yes 0 Income Clay Jerry 1 No ❑ Movie tied to Main St Glitter Party @ Galaxy o6 ❑ O'Malley Tom (introduced "The Pats 1 No [3Yes Q Income Movie tied to Main St Glitter Party @ Galaxy opE 13Yes Kelley Bob 1 ET©Income No [1ps Movie tied to Main St Glitter Party @Galaxy o ❑ 3 Verification l have read and understand FPPC Regulations 18944 1 and 18942. / have verified that the distribution of admissions, set forth above, is in accordance with the provisions. h_ x w,, i Wade G McKinney City Manager 03/31/2011 Signature of Agency Head or Designe 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 (866/275-3772) Agency Report of - Ceremonial Role Events and Ticket/Admission Distributions 1 Agency Name City of Atascadero or Region (if applicable) dress 6907 EI Camino Real Designated Agency Contact (Name, Marcia McClure Torgerson City Clerk 805-470-3400 1 mtorgerson@atasadero org 2 Function, Event, or Ceremonial Role Information Title Atas Main Street Glitter Receptip Description "The Patsy"/"Swingtime" screerib Date Stamp Pa z o�- 2— A A Public Document For Official Use Only ❑ Amendment (Must provide explanation in Part 3.) Date of Original Filing: 3/31/2011 (month, day, year) Face Value of Each Admission $ 9 00 Date(s) 3 19 2016 3 1 9 __j 1 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 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 Admisslon(s)f 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 Torgerson, Marcia 1 No ❑ © Movie tied to Main St Glitter Party @ Galaxy o6 13Yes Lewis, Jim 1 El No ❑ Income Movie tied to Main St Glitter Party @ Galaxy o6 13 McKinney Wade Yes 0 No ❑ Income Movie tied to Main St Glitter Party @ Galaxy o6 ❑ Yes ❑ Income No ❑ ❑ Yes ❑ Income No ❑ ❑ 3 Verification I have read and understand FPPC Regulations 18944 1 and 18942. 1 have verified that the distribution of admissions, set forth above, is in accordance with the provisions. Vj* � - &4—L—W I r Wade G McKinney City Manager 03/31/2011 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 (866/275-3772)