HomeMy WebLinkAbout803 Lisa Middleton 2019-11-13 John ManehanI'LGIV`I
Behested Payment Report A Publi�Ddic(1*IgaltLI-1 SPRINGS
1. Elected CiffieerorCPLICMember (Last name, Fiat name) 2019�pV 13 E5° 1
Middleton, Lisa
City of Palm Springs
3200 Tahquitz Canyon Way, Palm Springs CA 92262
OFFICE 0 THE CITY CLERn
6ehested Payment Report
Use
Designated Contact Person (Name and title, if different)
❑ Amendment (see Part s)
Date of Original Filing:
Area Code/Phone Number
E-mail (Optional)
760-507-7851
Lisa.middleton@paimspringsca.gov
(month, day, year)
2. Payor Information (Foraddiffonlal payors, include an attachment with the names and addresses.)
Name
�z C,. Pw(,\
Address city state
Zip code
3. Payee Information (For additional payees, include an attachment with the names and addresses.)
Equality California
Name
3701 Wilshire Blvd. /t 725 Los Angeles CA
90010
Address City state
Zip code
4. Payment Information (complete all intormaaon.)
Date of Payment: 10/19/2019 Amount of Payment: (in-IandFmv) $ 5c�'
(month, day, year) (Round to whole dollars.)
Payment Type: ❑x Monetary Donation or ❑ In -Kind Goods or Services (PmWdedescnphonbelow)
Brief Description of In -Kind Payment:
Purpose: (check one and proWde dewnplion below) ❑ Legislative []Governmental ❑p 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, to the best of my knowledge, the information contained
herein is true and complete.
November 13, 2019
Executed on By
DATE SIGNATURE OF ELECTED OFFICER OR EPUC MEMBER
FPPC Form $03 (January/2018)
FPPC Toll -Free Helpline: 866/ASK-FPPC (866/27S-3772)