HomeMy WebLinkAbout803 Lisa Middleton 2019-11-13 Aftab DadaBehested Payment Report
RECEIVED
A Public DdGUjkk$tit�LM SPRINGS Behested Payment Report
1. Elected Officer or CPUC Member (Last name. First name) y019 NO
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Middleton, Lisa
THE CITY CLEi=; ",
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Agency Name OFFICE
City of Palm Springs
Agency Street Address
3200 Tahquitz Canyon Way, Palm Springs CA 92262
Designated Contact Person (Name and title, if different)
❑ Amendment (seePan s)
Date of Original Filing:
Area Code/Phone Number
E-mail (Optional)
760-507-7851
Lisa.middleton@palmspringsca.gov
(monm,day. year)
2. Payor Information (For additional
�payors, G�0 ude al attachment with the names and addresses.)
Name 1.
Ue,e„ Cay . state zip Coft
3. Payee Information (For additional payees, include an attachment with fhe names and addresses)
Equality California
3701 Wilshire Blvd. # 725 Los Angeles CA 90010
Address City State Zip Code
4. Payment Information (Complete alimformabon)
10/19/2019
Date of Payment: Amount of Payment: on-macrFmv) $ fy—
(month, day, year) (Round to whole dollars)
Payment Type: ® Monetary Donation or ❑ In -Kind Goods or Services (amerce desmpdon below)
Brief Description of In -Kind Payment:
Purpose:(Check one and pmwde oescdpfion below) ❑Legislative ❑Governmental ❑x Charitable
Describe the legislative, governmental, charitable purpose, or event:
Donation to Equality California 2019 Palm Springs Awards Gala
5. Amendment Description and/or Comments
6. Verification
I certify, under penalty of perjury under the laws of the State of California, tha the best of my knowledge, the information contained
herein is true and complete.
November 13, 2019—
Executed on By
OATS SIGNATURE OF ELECTED OFFICER OR CPUC MEMBER
FPPC Form 803 (January/2018)
FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772)