Loading...
HomeMy WebLinkAbout803 Lisa Middleton 2019-11-13 Mike Brase:KECEIVED Behested Payment Report A PUNWDOWMe itRINGS Behested Payment Report 1. Elected Officer or Middleton, Lisa City of Palm Springs (Last name, First nanJEyt 19 NOV 13 OFFICE OF THE 3200 Tahquitz Canyon Way, Palm Springs CA 92262 Designated Contact Person (Name and title, if ditterem) Area Code/Phone Number E-mail (Optional) 760-50 1 Lisa.middleton@palmspringsca.gov 5- pp e Stamp CLEV ❑ Amendment(See Part5) For Olfical Use Only Date of Original Filing: (month. day. year) 2. Payor Information (Foradditional payors, include an attachment with the names and addresses.) name 0 c s _ 4 t - Lta ort- 3-to t t,J;1sVk.'A_ -4 'f2S (-as t-ARs (> g001 C Zip code 3. Payee Information (For additional payeesinclude an attachment with the names and addresses) Equality California Name 3701 Wilshire Blvd. # 725 Los Angeles CA 90010 Address City State Zip Code 4. Payment Information (Complete aninrormaaonl 00 Date of Payment: 10/19/2019 Amount of Payment: (n KndFmv) $ (month, day. )'ear) (RWrM to whole tlollars.J Payment Type: © Monetary Donation or ❑ In -Kind Goods or Services (Pmdde descapbon below) Brief Description of In -Kind Payment: Purpose: (Check one and pmode 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 Commgnts - v : VA 6. Verification I certify, under penalty of perjury under the laws of the State of herein is true and complete. - November 13, 2019 Executed on DATE the best of my knowledge, the information contained FPPC Form 803 (January/2018) FPPCTaII-Free Hetpline: 866/ASK-FPPC (866/275-3772)