09.d PW - Jellum park bench donation (002)14e
SCANDIA
PARK BENCH DONATION FORM
DONOR INFORMATION
Name:eJer�
Address: ; R G:: b y, h o r
PAID
NOV 2 3 2021
41'4g6'Iq
CITY OF SCANDIA
R'J e-- M o . C: Ctt, Parvi 0i)
Phone: La 51- -6 43 — 3 0 L 9 '
Email: b ' 1:-- ® 0.O l • C0 fn
13
Hereby gives to the City of Scandia $ 1486.49 for the purpose of Donatingp.
memorial RgLk bench to Lillesko en Park
M2 vy o r
Any funds in excess of the amount required for the above purpose:
() may be used for
(X ) 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.
Donor —�
Donor
Recommended
�-
DepartmVht Head
Accepted:
City Adminis ator
t�/ao/ aOZ
Date
Date
11/10/2021
Date
Dat