HomeMy WebLinkAbout803 Lisa Middleton 2019-12-30 Palm Springs ResortsBehested Payment Report A Public Document Behested Payment Report
1. Elected Officer or I
Lisa Middleton
Agency Name
City of Palm Springs
(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)
760-507-7851 lisa.middielon@paimspringsca.gov
RE6tVED
OF PALM SPRI
DEC 30 PH 4-
OF THE CITY CL
❑ Amendment (See Part 5)
Date of Original Filing:
(For additional payors, include a achment with the names and addresses)
Sv2tf—Y cc2TS
For Official Use Only
(monm. day. year)
Name o }� ` 4c>o 1 `/Ra..�.P�i ��Y1._i�l--�j S
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 (Complete all lntamation.) Cro
Date of Payment: It - Z S --ZO 1 � Amount of Payment: firmindFmo $ '500c
(month, day. year) (Roundlo whole db&m)
Payment Type: ® Monetary Donation or ❑ In -Kind Goods or Services(Pnwk/e descriptin below)
Brief Description of In -Kind Payment:
Purpose: (Check one andproWde description below) ❑Legislative ❑Governmental IN 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
herein is true and complete.
December 30, 2019
Executed on
DATE
to the best of my knowledge, the information contained
FPPC Form 803 (January/2018)
FPPCToll-Free Helpline: 866/ASK-FPPC (866/275-3772)