Gift disclosure form
Approval Status
*
Please select
Post to web
Name of member
*
First Name
Last Name
Nature of the gift or benefit
*
Source of the gift or benefit
*
Date of receipt
*
-
Month
-
Day
Year
Date Picker Icon
Circumstances under which the gift was received
*
Estimated value of gift
*
What will be done with the gift?
*
Will the gift, at any point, be left with the City?
*
Submit
Should be Empty: