HomeMy WebLinkAbout803 Lisa Middleton 2019-12-30 James Williamson & Geoff KorsBehested Payment Report
1. Elected Officer or CPUC Men
Lisa Middleton
Agency Name
City of Palm Springs
A Public Document
(Last name, First name)
3200 Tahquitz Canyon Way, Palm Springs CA 92262
Designated Contact Person (Name and title, if different)
Area Code/Phone Number E-mail (optional)
760-507 1 lisa.middleton@palmspringsca.gov
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PALM SPRINGS
AN 30 PM 4: 55
i)FFIdOF THE CITY CLEF.'
❑ Amendment (see Part 5)
Behested Payment Report
For Official Use Only
Date of Original Filing:
(month, day. year)
2. Payor Information (For additional payors, include an attachment with the names and addresses.y
Name
.Z
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. # 725 Los Angeles CA 90010
Address Cary State Zip Code
4. Payment Information (complete all lofa tbn.) e_c�
--Lc>tto
Date of Payment: t� 5 Amount of Payment: (In-Ko-aFmv) $ (s c
(month. day, year) (Round to whole dollars.)
Payment Type: I] Monetary Donation or ❑ In -Kind Goods or Services (Provide descdpdon below)
Brief Description of In -Kind Payment:
Purpose: (Check one andprovidedescription below) ❑Legislative ❑Governmental [9Charitable
Describe the legislative, governmental, charitable purpose, or event:
Donation to Equality California 2019 Palm Springs Awards Gala
5. Amendment Description and/or Comments
I was not made aware of this contribution until December 19, 2019.
6. Verification
I certify, under penalty of perjury under the laws of the State of
herein is true and complete.
December 30, 2019
Executed on By
DATE
to the best of my knowledge, the information contained
FPPC Form 803 (January/2018)
FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772)