HomeMy WebLinkAbout803 Lisa Middleton 2019-11-13 Eisenhower Health - Martin MassielloBehested Payment Re.
1. Elected Officer or CPUC
Middleton, Lisa
City of Palm Springs
/_1;
(Last name, First name)
Canyon Way, Palm Springs CA 92262
aul4iN SIV PRINGS
2019 Nov 13 �1e����+
OFFICE OF THE CITY CLER't
Area Code/Phone Number E-mail (Optional)
760-507-7851 Lisa.middleton@palmspringsca.gov
❑ Amendment (See Part 5)
Date of Original Filing:
2. Payor Information (Foraddilional payors, include an attachment with the
11names and addresses.)
L t,�, L owe.✓ L `ta k 4-t _ "la,✓ +-sw . L �� b
Behested Payment Report
For Official
(month, day
,.a„�c�c7c>o f�xb 11'.�1� \1✓ \�aA.-.�.�..-o��Vc>.S�t_ Lc_. �\`Z.Z1�l
city State Zip Code
3. Payee Information (Foradditionalpayess include an attachment with the names and addresses.)
Equality California
3701 Wilshire Blvd. # 725 Los Angeles CA 90010
.wumas Uny State Zip Code
4. Payment Information (Complete allmrormaoon.)
ZS �t>b
Date of Payment: 10/19/2019 Amount of Payment: pn-andPM7 $
(month, day, year) (Round M whole dollars)
Payment Type: ❑x Monetary Donation or ❑ In -Kind Goods or Services(Poovlde descnpbon below)
Brief Description of In -Kind Payment
Purpose:(Checkoneandpmvidedescnpdonbelow) El 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
1 certify, under penalty of perjury under the laws of the State of California,
herein is true and complete.
Executed on November 13, 2019
to the best of my knowledge, the information contained
FPPC Form 803 (January/2018)
FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772)