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HomeMy WebLinkAbout803 Lisa Middleton 2019-11-13 Gary KiefRECEIVED Behested Payment Report A FqifificCdoPc6 44ncfRINGS 1. Elected Officer or CPUC Member (Lastname, First nameinlp Middleton, Lisa GU 7 NOV 13 17 5 scam° City of Palm Springs Canyon Way, Palm Springs CA 92262 Area Codelldho 760-507-7851 2. Payor Information (Name and title, it different) OFFICE OF THE QIT`I OLF ❑ Amendment (Sea Pan 5) Behested For Of oal Use Only E-mail (Optional) Date of Original Filing: Lisa.middleton@palmspringsca.gov monm, day, year payors, include an attac lot with the names and addresses.) t V �l Ih/ --t name t C((,9Ce CulJev ��rc1 S�t�c 1oS C�t��vC. Ce. gez3Z Address City state Zip Cade 3. Payee Information (For additional payees, include an attachment with the names and addresses) Equality California Name 3701 Wilshire Blvd. R 725 Los Angeles CA 90010 Address City Slate Zip Code 4. Payment Information (Complete all informahon.) el?) 10/19/2019 Date of Payment: Amount of Payment: (ro-lOnd FMV) $ (month, day. year) (Round to whole dollars) Payment Type: ❑X Monetary Donation or ❑ In -Kind Goods or Services(Provlde description below) Brief Description of In -Kind Payment: Purpose: (Check we and prowde description below) ❑Legislative []Governmental ©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, at to the best of my knowledge, the information contained herein is true and complete. November 13, 2019 Executed on By PATE SIGNATURE OF ELECTED OFFICER OR CPUC MEMBER FPPC Form 803 (January/2018) FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772)