Breed Inaugural
Breed Inaugural
3. Payee Information (For additional payees, include an attachment with the names and addresses.)
Payment Type: 0 Monetary Donation or Din-Kind Goods or Services (Provide description below)
Purpose: (Check one and provide description below) 0 Legislative I1Governmental 0 Charitable
Describe the legislative, governmental, charitable purpose, or event:
Support mayoral inaugural events.
6. Verification
I certify, under penalty of perjury under the laws of the State of ifnithat othebes of my knowledge, theinformation contained
herein is true and complete.
Executed on 72 DATE
By
SIGNATURE OF ELECTED OFFICER OR cPuc MEMBER