HomeMy WebLinkAbout803 Robert Moon 2019-10-03 Darryl PonicsanBehested Payment Report
CEIVE D
. CITY DF PJ\LH SPRINGS A Public Documenr Behested Pay ment Report
1. Elected Officer or CPUC Member (Last name, First name)
Robert Moon
Agency Name
C ity of Palm Sp rings
Age ncy Street Address
3200 E Tahqu itz Canyon Way , Palm Spri ngs CA 92262
Des ig nated Contact Person (Na me and title, if different)
Anthony Meji a , City Clerk , City of Pa lm Sp ri ngs
Area Code/Phone Number
76 0 .83 2.8200
E-mail (Optio nal)
robert.moon@palmsp ri ngsca .gov
Daf6StJ?rM 12: 3 California 803
Form
CE OFT.,., CITY CL ;-1, · ForOfficialUseOnly
0 Amend men t (See Part 5)
Date of Original Filing : ----,-----
(month, day, yea r)
2. Payor Informat ion (For additional payors, include an attachment with the names and addresses.)
Darry l Pon icsan
Name
2982 Searchligh t Lane Palm Springs CA 92264
Address City State Zip Code
3. Payee Information (For additional payees. include an attachment with the names and addresses.)
City of Palm Sprin gs
Name
3200 E Tahquitz Canyon Way Palm Springs CA 92262
Address City State Zip Cod e
4 . Payment Information (Complete all infonnation.)
Date of Payment: SeptS,2 0 19 25 000 Amount of Payment: (ln-KindFMV) $ __ • ________ _
(Round to whole dollars.) (month, day, year)
Payment Type : (BJ Monetary Donation or D In-K ind Goods or Services (Provide description below.)
Brief Description of In-Kind Payment: -----------------------------
Purpose: (Check one and provide description below.) D Legis lative D Governmenta l IBl Charitable
Describe the legislative , governmental, charitable purpose , or event: Do nation to th e Fund Ra isin g Effort
to fund the preservation of the histo ric Palm Springs Plaz a Theatre , a city own ed property.
5. Amendment Description and/or Comments
6. Verification
I certify, under penalty of perjury under th e laws of th
herei n is true and complete .
Executed on ____ o_c_t _3 •_2_0_1_9 __ _
DATE
st of my knowled ge , the information contai ned
FPPC Form 803 (January/2018)
FPPC Toll -Free Helpli n e: 866/ASK·FPPC (866/275-3772)