9.c) Lion's Donation for ProjectorISK
SC_ NDIA
DONOR INFORMATION
Name:
Addres
Phone:
Email:
MONETARY DONATION FORM
gives to the City of Scandia $ ZI C9-t IS tlCp tl _ for the purpose of nl, y Q
Any funds in excess of the amount required for the above purpose:
( ) maybe used for 2
() shall be returned to the Donor
() may be applied to any other project or fund deemed appropriate by the City Council of the
City of Scandia
The City of Scandia will make reasonable efforts to accommodate the intended purpose of the
donation but reserves the right to utilize, relocate and/or dispose of any item through donated
funds as the City of Scandia may deem fit.
"0", �-�' � 6AlalILF
Donor Date
Donor Date
Recommended:
Department Head Date
Accepted
City Administrator Date