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rayment to Agen <br />. Agency Name <br />City of Brea <br />D v s on, Department, <br />Fire Department <br />Street Address <br />1 Civic Center Circle <br />Area CodelPhone Nun <br />714-990-7757 <br />A Public Document <br />or Kegton Of appkable) <br /> <br />nate Stamp <br />REPOWr <br />For Motel Use Only <br />Amendment(explain in comment section) <br />Agency Contact (name and tale) Date of Original Filing: <br />(momh, day. Year) <br />Lillian Hams -Neal <br />Donor Name and Address <br />Wait Disney Company <br />❑ Individual Last Name First Nam Q Other Name <br />P.O. Box 3232 Anaheim CA 92803 <br />Address City state Zip Code <br />Amusement Park <br />lf'Other' is merited, describe the ardWs business activity (it business) or as r sure and Interests. <br />�j If applicable, identify the name of each source and the amounts) received by the donor for this payment: <br />Name $ Amount Noma Amount <br />3. Payment Information (Complete Sections 3.1 (a or b), 3.2, 3.3) <br />3.1 (a) Travel Payment <br />Leeallon of Travel Dates (month, day, year) <br />❑ Rail ❑ Air ❑ Bus ❑ Auto p Other <br />Transportation Provider Chaek Applicable Boxes Namo Sire Facility <br />lodging Expenses Meal Expenses ronspdtadan Expenses $ Other Expenses Total Expenses <br />3.1 (b) Payment(s) not related to travel: 2-14-2018 $ 14,896.00 <br />Dates (mordh, day, year) Total Expenses <br />3.2. Payment Description. Provide a specific description of the payment and its agency purpose and use. <br />Tickets given in appreciation of fire services provided to the state during recent wildfire. <br />3.3. identify the officials who used the payment in Section 3.1 (see instructions) <br />See Attached <br />Last Name Fust Nome Positionne Departmant/Divlslon <br />Last Name First Name Posltione"Me Departm entlDiNajan <br />4. Verification <br />I the ' <br />Uptanof the repotted pay a t(s) as inZcopI' ce with FRPC regu tions. <br />n/ ?,/V ( M112,01 <br />signatureAA �� rtm Name Title year) <br />Comment. lT 1/ �t <br />,Use this spate or an attachment far any <br />FPPC Form 801 (Janl18) <br /> <br />