HomeMy WebLinkAbout803 Lisa Middleton 2019-12-30 Palm Springs Hospitality Assn.Behested Pad
1. Elected Office
Lisa Middleton
ent Report
or
City of Palm Springs
A Public Document
(Last name, First name)
3200 Tahquitz Canyon Way, Palm Springs CA 92262
Dale Stag
OF FP.Lh SPRING
0_C 30 FM �' 55
OFNI E Of THE CITY CL`
❑ Amendment (see Fan 5)
Behested Payment Report
ForOfficial Use Only
Area CodeiPhone Number E-mail (optional) Date of Original Filing:
760-507-7851 lisa.middleton@palmspringsca.gov (month, day. year)
2. Payor Infp�J¢lation (For additional payors, include an attachm�e7nt with the names and addre s.)
`.mot i T N-t-A
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 City State Zip Code
4. Payment Information (cmidiete an inicmerion.)
Date of Payment: k t - Z S —I C( Amount of Payment: (m-rondMo $
(month, day, year) (Round to whole doaars)
Payment Type: ® Monetary Donation or ❑ In -Kind Goods or Services (Pmvkledescription below)
Brief Description of In -Kind Payment:
Purpose:(Check one and proNdedescdptonbelow) ❑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
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
to the best of my knowledge, the information contained
FPPC Form 803 (January/2018)
FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772)