801 Payment to Agency Report (Wafu School of Ikebana)
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Payment to Agency Report A Public Document PAYMENT TO AGENCY REPORT
California
Form
1. Agency Name
Agency Contact (name and title)
Street Address
Amendment
Date Stamp
Email
Division, Department, or Region (if applicable)
801
(month, day, year)
For Official Use Only
Area Code/Phone Number
Date of Original Filing:
(explain in comment section)
2.Donor Name and Address
Individual Other NameLast Name First Name
Address City State Zip Code
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:
$ $ 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
Check Applicable Boxes
Auto Other
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.
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.
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
Pamela Wu (Mar 28, 2025 09:24 PDT)
Pamela Wu
City of Cupertino
City Manager
10300 Torre Ave., Cupertino CA 95014
408-777-3225 kirstens@cupertino.gov
Kirsten Squarcia, City Clerk
n
Wafu School of Ikebana, California Chapter
22576 Poppy Drive Cupertino CA 95014
School for Japanese art of floral arranging
Fusako Hoyrup 200.00
Flower arrangement donation for display at City of Cupertino State of the City event on 2/26/25
Pamela Wu City Manager Mar 28, 2025
801 Wafu School of Ikebana_022625
Final Audit Report 2025-03-28
Created:2025-03-28
By:Kirsten Squarcia (kirstens@cupertino.org)
Status:Signed
Transaction ID:CBJCHBCAABAAXjFZcptME3OL40oEJYL8DJ5loQerklTq
"801 Wafu School of Ikebana_022625" History
Document created by Kirsten Squarcia (kirstens@cupertino.org)
2025-03-28 - 4:01:39 AM GMT
Document emailed to pamelaw@cupertino.gov for signature
2025-03-28 - 4:03:21 AM GMT
Email viewed by pamelaw@cupertino.gov
2025-03-28 - 4:04:01 AM GMT
Signer pamelaw@cupertino.gov entered name at signing as Pamela Wu
2025-03-28 - 4:24:49 PM GMT
Document e-signed by Pamela Wu (pamelaw@cupertino.gov)
Signature Date: 2025-03-28 - 4:24:51 PM GMT - Time Source: server
Agreement completed.
2025-03-28 - 4:24:51 PM GMT