HomeMy WebLinkAbout801 Form - Marjorie T. Houston’s Revocable Living Trustyment to Agency Report A Public Document
4gency Name
City of Cupertino
)ivision, Department, or Region (if applicable)
Parks and Recreation
Street Address
10300 Torre Ave., Cupertino CA 95014
Area Code/Phone Number Email
408-777-3225 LaurenS(cDcupertino.gov
Agency Contact (name and title)
Lauren Sapudar, City Clerk
2. Donor Name and Address
PAYMENT TO AGENCY REPORT
Date Stamp •
RECEIVED
For Official Use Only
AUG 0 6 2026
'ERTINO CITY CLERK
❑ Amendment (explain in comment section)
Date of Original Filing:
(month, day, year)
❑ Individual Houston Marjorie ❑Other Marjorie T. Houston's revocable living trust
Last Name First Name Name
CA
Address City State Zip Code
Check donation to 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:
Marjorie T. Houston $19966 $
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.
Donation: $1,996.66 Check to Senior Center as needed. (City was named as a beneficiary in former Senior
Center Member Marjorie T. Houston's revocable living trust)
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 authorized the acceptance of the reported payment(s) as in compliance with FPPC regulations.
Tina K�(Aup 6, 2026 145856 PDT) Tina Kapoor City Manager 08/06/2026
Signature Print Name Title (month, day, year)
Comment:
(Use this space or an attachment for any additional information)
FPPC Form 801 (Jan/18)
advice@fppc.ca.gov
Clear Page • Print Form
Donated By
Item
Estimated
Value
Houston Living Trust
Date Donation Approved: 05/07/26
Donation: $1,996.66 Check to Senior Center as needed.
(City was named as a beneficiary in former Senior Center
Member Marjorie T. Houston's revocable living trust)
Monetary Donation
$1996.66
CA Form 801
Final Audit Report
Created: 2026-08-06
By: Melissa Robertson (melissar@cupertino.gov)
Status: Signed
Transaction ID: CBJCHBCAABAAakQE8ZQYop3SLSsylxyVbgHSjDU2SUWk
"CA Form 801" History
Document created by Melissa Robertson (melissar@cupertino.gov)
2026-08-06 - 9:43:56 PM GMT
t Document emailed to Tina Kapoor (TinaK@cupertino.gov) for signature
2026-08-06 - 9:44:00 PM GMT
Email viewed by Tina Kapoor (TinaK@cupertino.gov)
2026-08-06 - 9:44:36 PM GMT
2026-08-06
6Q Document e -signed by Tina Kapoor (TinaK@cupertino.gov)
Signature Date: 2026-08-06 - 9:58:56 PM GMT - Time Source: server - Signature Appearance Selected: MOBILE_DRAW
O Agreement completed.
2026-08-06 - 9:58:56 PM GMT
Q Adobe Acrobat Sign