HomeMy WebLinkAbout801 Payment to Agency Report (S. Ku Foundation)Payment to Agency Report
1. Agency Name
City of Cupertino
A Public Document
Division, Department, or Region (if applicable)
Parks and Recreation
Street Address
10300 Torre Ave., Cupertino CA 95014
Area Code/Phone Number Email
408-777-3225 Lauren Scupertino.gov
Agency Contact (name and title)
Lauren Sapudar, Acting City Clerk
2. Donor Name and Address
Ku Ling
❑ Individual
Last Name First Name
ED Stamp
V
MARO9 9 2026
CUPERTI O CITY CLERK
❑Other
PAYMENT TO AGENCY REPORT
For Official Use Only
❑ Amendment (explain in comment section)
Date of Original Filing:
Name
(month, day, year)
16001 Wood
Address State Zip Code
Donation: $3,500 Check to Cupertino Senior Center ($3,000 for Ginger Tsun's teaching fee for one year of Dancercise, $500
should cover insurance, the remaining amount for senior center)
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.
Ling Ku (S. Ku Foundation) $ 350000 $
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)
Transportation Provider
❑ Rail ❑ Air ❑ Bus ❑ Auto ❑ Other
Check Applicable Boxes Name of Lodging Facility
$ $
Lodging Expenses Meal Expenses
3.1 (b) Payment(s) not related to travel:
$ $ $
Transportation Expenses Other Expenses Total Expenses
Dates (month, day, year) Total Expenses
3.2. Payment Description. Provide a specific description of the payment and its agency purpose and use.
Ginger Tsun's teaching fee for one year of Dancercise, $500 insurance, remainder for senior center.
3.3. Identify the officials who used the payment in Section 3.1 (See instructions)
Last Name First Name
Last Name
First Name
Positions Title
Position/Title
Department/Division
Department/Division
4. Verification
I autho cceptance f -the reported payment(s) as in compliance with FPPC regulations.
Tina Kapoor City Manager
Signature Print Name Title (month, da , year)
Comment:
(Use this space or an attachment for any additional information) FPPC Form 801 (Jan/18)