HomeMy WebLinkAbout803 Lisa Middleton 2019-04-04 Harold MatznerBehested Payment Report A Public Document =: �: ::.
Behested Payment Report
1. Elected Officer or CPUC Member (Last name, First name)
Date Stamp
Middleton, Lisa
`19 !i1 1�"�} PI-1Agency 3:al
"For Use Only
Name
Palm Springs City Council
Agency Street Address
3200 Tahquitz Canyon Way, Palm Springs CA 92262
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Designated Contact Person (Name and title, if different)
- c
❑ Amendment (see Pan 5) ;
Date of Original Filing:
=
Area Code/Phone Number
E-mail (Optional)
760-507-7851
Lisa.middleton@palmspringsca.gov
(month,. day, yeal
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2. Payor Information (For additional payors, include an attachment with the names and addresses.)
-t7
Harold Matzner
Name
181 S Civic Drive Suite 1 Palm Springs CA 92262
0
Address City State
Zip Code
3. Payee Information (For additional payees, include an attachment with the names and addresses.)
Veterans for Peace
Name
151 Lincoln Downs St. Rancho Mirage CA 92270
Address City State
Zip Code
4. Payment Information (Complete all information.)
Date of Payment: 04/03/2019 Amount of Payment: (In -Kind FM%0 $ $5000.00
(month, day, year) (Round to whole dollars.)
Payment Type: ® Monetary Donation or ❑ In -Kind Goods or Services (Provide description below.)
Brief Description of In -Kind Payment:
Purpose: (Check one and provide description below.) ❑ Legislative ❑ Governmental ® Charitable
Describe the legislative, governmental, charitable purpose, or event: The unveiling of the LGBTQ Veterans
Memorial at Desert Memorial Park on April 27, 2019 and the ensuing luncheon
5. Amendment Description and/or Comments
6. Verification
I certify, under penalty of perjury under the laws of the State of Cali7RN
ihat to the best of my knowledge, the information contained
herein is true and complete.
Executed on
DATE
By
i--4100,
SIGNATURE OF ELECTED OFFICER OR CPUC
FPPC Form 803 (January/2018)
FPPC Toll -Free Helpline: 866/ASK-FPPC (866/27S-3772)