HomeMy WebLinkAbout803 Lisa Middleton 2019-11-13 Gregory HellerRECEIVED
Behested Payment Report A PUBIFCyDb'Cu7rAbt*SPRING5
1. Elected Officer or CPUC Member (Last name First name) 2019 NOV 13 PM 5itel9amp
Middleton, Lisa �1 YY
vgency Name OFFICE OF TIi CITYCLF',
City of Palm Springs
3200 Tahquitz Canyon Way, Palm Springs CA 92262
(Name and title, it different)
❑ Amendment (see pans)
Area Code/Phone Number E-mail (Optional) Date of Original Filing:
760-507-7851 Lisa.middleton@palmspringsca.gov
Payor Information (For additional payom include an a achment with the names and addresses.)
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Behesled Payment Report
For Otfidal Use Only
(month, day, year)
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3. Payee Information (For additional payees, include an attachment with the names and addresses.)
Equality California
3701 Wilshire Blvd. # 725
Los Angeles
CA 90010
4. Payment Information (Complete ab,mom,abon)
Date of Payment: 10/19/2019 Amount of Payment: (In-undFn+v) $�
(month, tlay, year) (Round to whole tlplla/5 )
Payment Type: ❑x 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 ❑Govemmental ❑O 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, t t to the best of my knowledge, the information contained
herein is true and complete.
November 13, 2019 1
Executed on By.
PATE &GNATURE OF ELECTED OFFICER OR CPUC MEMBER
FPPC Form 803 (January/2018)
FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772)