2024-04-01 801 Payment to Agency Report A Public Document PAYM - ; A ; EPORT
1.Agency Name Sta aii torn
Form �'
Division,Department,or Region(if applicable) officia t. ly
g APR 012(�Y4
2263 Santa Clara Ave., Room 320
Street Address CITY'OF ALAMEDA
Alameda CA 94501 CITY CLERK'S OFFICE
Area Code/Phone Number Email
5107474700 jowens@alamedaca.gov ❑ Amendment(explain in comment section)
Agency Contact(name and title) Date of Original Filing:
(month,day,year)
Jodi Owens, Executive Assistant
2. Donor Name and Address
El Individual Other Yeongdong Gun County Office, South Korea
Last Name First Name Name
1 Dongjeong-ro,Yeongdong-eup Yeongdong-gun, Chungcheongbuk-do 29140
Address City State Zip Code
Gift from Sister City Yeongdong-gun, South Korea
If"Other"is marked,describe the entity's business activity(if business)or its nature and interests.
If applicable, identify the name of each source and the amount(s)received by the donor for this payment:
$690.00 $
Name Amount Name Amount
3. Payment Information (Complete Sections 3.1 (a or b), 3.2, 3.3)
3.1 (a)Travel Payment
Location of Travel Dates(month,day,year)
❑Rail ❑Air ❑Bus ❑Auto ❑Other
Transportation Provider Check Applicable Boxes Name of Lodging Facility
$ Lodging Expenses $ Meal Expenses Transportation Expenses $ Other Expenses $ Total Expenses
3.1 (b) Payment(s) not related to travel: $
Dates(month,day,year) Total Expenses
3.2. Payment Description. Provide a specific description of the payment and its agency purpose and use.
Musical instrument
3.3. Identify the officials who used the payment in Section 3.1 (See instructions)
Last Name First Name Position/Title Department/Division
Last Name First Name Position/Title Department/Division
4.Verification
I au oriz d-the acceptance of the reported payment(s)as in compliance with FPPC regulations.
ignature Print Name Title (month,day,year)
Com t:
(Use this space or an attachment for any additional information) FPPC Form 801 (Jan/18)
advice@fppc.ca.gov
fppc.ca.gov
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Instrument
This one came with a stand, but the one the Mayor got did not.
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6 , Korea Traditional Ban Korean Instruments
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Haegeum Korean Style viola with Hard Case(Made
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Brand Panasonic Qty 1..,
Color B`ack
1 Top Matenal Ash Wood
Type
Back Materat Ash Wood
Type
Instrument viola
Lu.:), I item Weight 1 Kilograms
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Number of 4
Strings
New(2)from
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