Agency Report of: Ceremonial Role Events and Ticket/Pass Distributions

Form 802 Instructions



Must Provide Explanation in Part 3


Part 1 of 4: Agency Information







Part 2 of 4: Function or Event Information

Does the agency have a ticket policy?






Ticket(s)/Pass(es) provided by agency?




Was ticket distruibution made at the behest of agency official?



Part 3 of 4: Recipients

Section A: First Name of Agency, Department or Unit




Section A: Second Name of Agency, Department or Unit




Section A: Third Name of Agency, Department or Unit




Section A: Fourth Name of Agency, Department or Unit




Section A: Fifth Name of Agency, Department or Unit




Section A: Sixth Name of Agency, Department or Unit




Section B: First Individual



Identify one of the following




Section B: Second Individual



Identify one of the following




Section B: Third Individual



Identify one of the following




Section B: Fourth Individual



Identify one of the following




Section B: Fifth Individual



Identify one of the following




Section B: Sixth Individual



Identify one of the following




Section C: First Outside Organization




Section C: Second Outside Organization




Section C: Third Outside Organization




Section C: Fourth Outside Organization




Section C: Fifth Outside Organization




Section C: Sixth Outside Organization





Part 4 of 4: Verification

I have read and understand FPPC Regulations 18944.1 and 18942. I have verified that the distribution set forth above, is in accordance with the requirements.





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End of Page, Form 802.