Watch Dog.

Gift to Agency Report A Public Document GtFT TO AGENCY REPORT
1. Agency Name
Secretary of State
Division, Department, or Region (if applicable)
1500 11 th Street
Street Address
Sacramento, CA 95814
Area Code/Phone Number E-mail
916-653-6974 frederick.radcliffe@sos.ca.gov
Agency Contact (name and title)
Frederick Radcliffe, Filing Officer
2. Donor Name and Address
o Individual _.,.--,~ _______ -::--,...,.,-____ _
Last Name First Name
1111 Exposition Blvd. #302 Sacramento
Address City
~ Other
Date Stamp .C~lifornia 801
Form
For Official Use Only
o Amendment (explain IrI comment section)
02/02/2010 Date of Original Filing: __ --,--, __ -,-_
(manti I. day. year)
Robert M Scherer & Associates, Inc.
Name
CA 95815
Slate ZIP Code
Dale Carnegie Training franchise in Sacramento. Provides "Continuing Education and Training".
If "Other" IS marked. describe the entlty's business activity (if business) or its nature and IIlterests
If applicable, identify the name of each source and the amount(s) solicited or received by the donor for this gift
Name
3. Payment Information
$-----:---Amount
Date and Amount of Payment (other than travel) 01/22/2010
(month. day, year)
------~------- $--~~--- Name Amount
3590.00
$----::::-----,-,----,-.,....--,-::--,---
(Round to whole dollars)
Travel Payment Information (Round to whole dollars) Location of Travel ___________________ _
Date(s) of Travel
$ $~~~--
Transportation Expenses Lodging Expenses
$---;-:--;-;,.---Meal
Expenses
$--;:,,.,----,----Ottler
Expenses
$~-,-;-;"--Total
Expense!:'
Provide a specific description of the nature and use of the payment for official agency business:
Two scholarships provided to cover tuition costs for attendance at a Dale Carnegie program entitled "Leadership
Training for Managers". Location of program is in Sacramento, CA and consists of 7 half-day weekly seminars starting
on 02/02/2010.
Identify the officials for whom the payment was used:
Monterose James Training Officer II Management Services
Last Name First Name Tille DepartmentlDlvlslon
Mejia Dora Chief, MSD Management Services
Last Name Fllst Name Tille Department/DIvIsion
4. Verification
I have determined that it is in the interests of the agency to accept this gift and use it for the offiCial agency bUSiness described a/Jove.
~\VV\.,oLA,/V ~~ Janice Lumsden
--------~P~fI~nt~N~a-m-e----------
omment: (Use this space or an attachment for any additIOnal information.)
Deputy Secretary of State 02102/2010
Title (month. day. year)
FPPC Form 801 (June/OB)
FPPC Toll-Free Helpline: B66/ASK-FPPC (866/275-3772