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HomeMy WebLinkAbout803 Christy Gilbert Holstege 2020-01-02 Donna MacMillanBehested Payment Report A Public DocurnlillfitEI y ED Beheslad Payment Report 1. Elected Officer or CPU Member (Last name, First name) V1 I r V - r lr� tDM98dNGS • • , Christy Gilbert Holstege —2 PM 3: 40 • e For Official Use Only Agency Name City of Palm Springs OFFICE F THE CITY CL E", Agency Street Address 3200 E Tahquitz Canyon Way Designated Contact Person (Name and title, it different) ❑ Amendment (sea Part S) Christy Gilbert HOlslege Date of Original Filing: (month. day, yew) Area Code/Phone Humber E-mall (Optlonan (760) 323-6299 christy.holstege@palmspdngsca.gov 2. Payor Information (For additional payom, include an attachment with the names and addresses.) Donna MacMillan 74695 Wren Dr. Indian Wells CA 92210 Address Gry State Zip Code 3- Payee Information (For additional payees, include an attachment with the names and addresses.) Equality California 3701 Wilshire Blvd, Suite 725 4. Payment Information (complete am Information.) Los Angeles CA 90010 Date of Payment: 10/21/2019 Amount of Payment: (In-WndFMv) $ 5,000 (month, day, year) (Round to whole dollars.) Payment Type: ® Monetary Donation or ❑ In -Kind Goods or Services (Fronde descdptbn below) Brief Description of In -Kind Payment: Purpose:(Chec one and provide description below) ❑Legislative ❑Governmental IN Charitable Describe the legislative, governmental, charitable purpose, or event: Equality California Palm Springs Awards 2019 5. Amendment Description and/or Comments I am not aware of the actual date the payment was received. 6. Verification I certify, under penalty of perjury under the laws of the State of California, that to the best of my knowledge, the information contained herein is true and complete. Executed on 1/2/2020 B _ 01 I DATE y IGNATURE aF ELECTED OF ER OR CPUC MEMBER r FPPC Form 803(January/2018) FPPC Toll -Free Helpline: 866/A5K-FPPC (866/275-3772)