801 Payment to Agency Report (Parks and Recreation - Senior Center)Payment to Agency Report A Public Document
1. Agency Name
City of Cupertino
Division, Department, or Region (if applicable)
City Manager / City Clerk's Office
Street Address
10300 Torre Ave., Cupertino CA 95014
Area Code/Phone Number Email
408-777-3225 kirstens@cupertino.gov
Agency Contact (name and title)
Kirsten Squarcia, City Clerk
2. Donor Name and Address
❑ Individual
Last Name
First Name
Date Stamp
RECEIVED
JUL 292025
'ERTINO cm
PAYMENT TO AGENCY REPORT
For Official Use Only
❑ Amendment (explain in comment section)
Date of Original Filing:
❑ Other
Various Donors
Name
(month, day, year)
Address City State Zip Code
Various monetary contributions to the 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:
(See attached itemized list) $ $
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 El 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.
Monetary donations for Parks and Recreation Senior Center. (as noted in attached form)
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. Verificatio),n�
I t�iorize¢- cceptan of the reported payment(s) as in compliance with FPPC regulations.
Tina Kapoor Interim City Manager
Signature Print Name Title (month, ay, year)
Comment:
(Use this space or an attachment for any additional information)
FPPC Form 801 (Jan/18)
advice@fppc.ca.gov
Form 801- 2025 Parks & Recreation Itemized List — Monetary donations to the Senior Center.
Donated By
Item
Estimated
Value
Ling Ku (S. Ku Foundation)
Monetary Donation
$3500
Date Donation Approved:
01/28/25
Donation: $3,500 Check to
Cupertino Senior Center ($2,800
for Ginger Tsun's Dancercise
instruction fee, $700 for class
insurance fee and Senior Center
needs)
Houston Living Trust
Monetary Donation
$70,000
Date Donation Approved:
05/20/25 (by City Council)
Donation: $70,000 Check (City
was named as a beneficiary in
former Senior Center Member
Marjorie T. Houston's revocable
living trust)