HomeMy WebLinkAbout803 Robert Moon 2019-10-02 Palm Springs ResortsRFCFiV[n
menesieo raynneni Keporr A VUDIIC 11-0
. � W Behested Payment Report
1. Elected Officer or CPUC Member(Last name, First name)
Date Stamp7For
Moon, Robert 21119
CT _2 PM 136Agency
Name
City of Palm Springs OFFICE
OF THE CITY CLEM
70nly
Agency Street Address
3200 E Tahquitz Canyon Way, Palm Springs CA 92262
Designated Contact Person (Name and title, Wdi//erent)
❑ Amendment (see Parts)
Anthony Mejia, City Clerk, City of Palm Springs
Date of Original Filing:
Area Code/Phone Number
E-mail (Optional)
7603238200
robert.moon@palmspringsca.gov
month, day, year)
2. Payor Information (For additional payors, include an attachment with the names and addresses.)
Palm Springs Resorts attn: Tamara Stevens
189 W. Amado Road Palm Springs CA 92262
Address City State Zip Code
3. Payee Information (For additional payees, include an attachment with the names and addresses.)
City of Palm Springs
Name
3200 E. Tahquitz Canyon Way Palm Springs CA 92262
4. Payment Information (Complete all inrormatton.)
Sept24,2019 $5000
Date of Payment: Amount of Payment: (in -Grid FMl) $
(month, day, year) (Round to whole dollars)
Payment Type: ❑x Monetary Donation or ❑ In -Kind Goods or Services (Provide description below)
Brief Description of In -Kind Payment:
Purpose: (Check one and provide description below) ❑Legislative ❑Governmental ❑p Charitable
Describe the legislative, governmental, charitable purpose, or event: Donation to the City of Palm Springs
fund for the annual Veterans Day Parade and Celebration
5. Amendment Description and/or Comments
6. Verification
I certify, under penalty of perjury under the laws of the
herein is true and complete.
Executed on
October 2, 2019
DATE
By
the best of my knowledge, the information contained
FPPC Form 803 (January/2018)
FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772)